A Narrative Review of the Diagnostic Performance of Non-Invasive Scores for Predicting Fibrosis in MAFLD
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Background & aim: The burden of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) is increasing, with an estimated prevalence of 32.4% globally. Although most patients present with simple steatosis, some progress to advanced fibrosis, cirrhosis, and hepatocellular carcinoma. Non-invasive scores offer a promising alternative to liver biopsy for fibrosis staging. This narrative review aims to compare the diagnostic performance of non-invasive scores for in detecting fibrosis in patients with MAFLD, with a focus on identifying the most accurate and reliable score.
Methods: This narrative review included studies with histologically confirmed fibrosis staging. The primary outcome was the overall diagnostic accuracy of each score in predicting significant fibrosis (F2-F4) and advanced fibrosis (F3-F4). Secondary outcomes included sensitivity, specificity, and positive and negative predictive values.
Results & Conclusion: Our analysis included a total of 11 studies with 5761 patients. The overall diagnostic performance for predicting advanced fibrosis was highest for Magnetic Resonance Elastography (MRE), followed by Transient Elastography (VCTE). In predicting significant fibrosis, Hepamet Fibrosis Score (HFS) demonstrated the highest performance. Significant variation was observed across studies, which was partially explained by differences in the prevalence of advanced fibrosis and the specific thresholds utilized for each score.
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