Commentary
For Y. J. Zhou, et al., there is an urgent need to identify patients who are at risk of developing NASH. Traditional, non-invasive tests have been developed to identify either NASH or advanced fibrosis. However, these tests do not accurately detect patients who are at risk of NASH.
Harrison et al. developed and validated the NIS4 test that provides an effective way to rule in or rule out patients at risk of developing NASH. There are only two other non-invasive tests that can be used to detect patients at risk of NASH: the FAST and MACK-3 scores. The NIS4 score, and the MACK-3 score are blood-based diagnostic tests, whereas the FAST score is principally derived from FibroScan.
These non-invasive tests usually provide two cut-off points: one with the highest sensitivity and one with the highest specificity. Consequently, between these two cut-off points there is a so-called grey zone of indeterminate results.
The authors propose that the sequential combination of NIS-4, MACK-3, and FAST scores might help to narrow the grey zone and further avoid unnecessary liver biopsies. Sequential combination of these three newly developed non-invasive tests to better identify patients who are at risk of developing NASH warrants further research.
