For the management of NASH, non-alcoholic steatohepatitis, stratifying disease severity is essential for implementing treatment and management strategies. Although liver biopsy is the standard for understanding fibrosis severity, there are also non-invasive tests such as FIB-4 and vibration-controlled transient elastography, VCTE. This study compared how physicians used their own cut-off values versus the reference thresholds to understand the differences and subjectivity of these ratings. It was found that despite recommendations, NAFLD often goes underdiagnosed and underestimated with many physicians not using formal risk-stratification tools. Underestimation was found to be more common than overestimation, meaning patients with advanced fibrosis are not being treated appropriately. This was found to vary by specialties – diabetologists tended to underestimate, while hepatologists had higher overestimation rates. Both under- and overestimation are undesirable, leading to concerns of a lack of appropriate treatments for patients with NAFLD.
This review by Anstee QM et al. aimed to compare subjective physician assessments of fibrosis versus the recommended reference thresholds to understand differences in clinical settings.
More guidance and education are needed to ensure that physicians accurately stratify a patient’s fibrosis stage to allow for appropriate treatment and management. These risk stratification tools require standardised interpretations for optimal care delivery.