Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease

TLDR

Clinical predictors of advanced non‑alcoholic fatty liver disease are needed to guide diagnosis and treatment, prompting analysis of 827 patients across two tertiary centers to characterize demographics and risk factors. The study aimed to identify demographic and clinical risk factors for advanced fibrosis in NAFLD patients. Using forced‑entry logistic regression, the authors combined BMI ≥ 28 kg/m², AST/ALT ratio ≥ 0.8, and diabetes into a weighted BARD score to predict advanced fibrosis. The BARD score, assigning 1 point for BMI ≥ 28 kg/m², 2 points for AST/ALT ratio ≥ 0.8, and 1 point for diabetes, achieved an odds ratio of 17 for advanced fibrosis at scores 2–4 and a 96 % negative predictive value, reliably excluding advanced disease, especially in non‑diabetics.

Abstract

Clinical predictors of advanced non-alcoholic liver disease (NAFLD) are needed to guide diagnostic evaluation and treatment.To better understand the demographics of NAFLD and risk factors for advanced disease, this study analysed 827 patients with NAFLD at two geographically separate tertiary medical centres.The cohort was 51% female and had a median body mass index (BMI) of 33 kg/m(2); 3% had a normal BMI. Common co-morbidities included hypertension (60%) and diabetes (35%); insulin resistance was present in 91% and advanced fibrosis in 24% of patients. When comparing patients with no fibrosis or mild fibrosis to those with advanced fibrosis, BMI > or = 28 kg/m(2), age > 50 years, and aspartate transaminase/alanine aminotransferase (AST/ALT) ratio > or = 0.8, a quantitative assessment check index (QUICKI) score < 0.294 (equivalent to homeostasis model assessment (HOMA) > 6.2) and the presence of diabetes mellitus (DM) were individually associated by univariate analysis with odds ratios (ORs) of > or = 2.4 for advanced fibrosis. Based on the results of forced entry logistic regression analysis, three variables were combined in a weighted sum (BMI > or = 28 = 1 point, AAR of > or = 0.8 = 2 points, DM = 1 point) to form an easily calculated composite score for predicting advanced fibrosis called the BARD score. A score of 2-4 was associated with an OR for advanced fibrosis of 17 (confidence interval 9.2 to 31.9) and a negative predictive value of 96%.Insulin resistance and its co-morbidities are often present in patients with NAFLD. An easily calculated score based on readily available clinical data can reliably exclude the presence of advanced fibrosis in these patients, particularly among non-diabetics.