Clinical

New scoring system rules out advanced liver fibrosis

Last Updated: 2008-10-17 17:27:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A simple scoring system accurately identifies patients with nonalcoholic fatty liver disease (NAFLD) who don't have advanced disease, according to a report in the October issue of Gut.

The "BARD" score was developed to incorporate 1 point for a BMI of at least 28, 2 points for AST/ALT ratio of 0.80 or greater, and 1 point for diabetes.

A BARD score of 2-4 has a positive predictive value of 43% and a negative predictive value of 96% for detecting stage 3-4 fibrosis, the researchers note.

"If the BARD score is < 2, physicians can be reassured the patient does not have advanced liver disease, and if the patient has a BARD score of 2 or greater, they really need to be concerned and take action," Dr. Stephen A. Harrison from Brooke Army Medical Center, San Antonio, Texas, told Reuters Health.

Dr. Harrison and colleagues defined the clinical, laboratory, and histopathological characteristics of 827 patients with biopsy-proven NAFLD and developed a simple clinical scoring system for identifying patients with advanced fibrosis.

Compared with patients having fatty liver alone, patients with nonalcoholic steatohepatitis (NASH) were older, heavier, predominantly female, hypertensive, diabetic, insulin resistant and had a higher ALT and AST, the authors report.

Patients with stage 3-4 fibrosis were also likelier than patients without fibrosis to be older, female, diabetic, insulin resistant, and to have higher AST/ALT ratios.

Based on additional analyses, the investigators found that the BARD score was at least equivalent to the more complex NAFLD fibrosis score in excluding patients with advanced fibrosis.

A simple scoring system that relies on only three clinical features was validated in a large group of patients. BARD "may assist clinicians in targeting those patients in need of liver biopsies to confirm the diagnosis and guide management, particularly among patients with diabetes," the authors conclude.

Gut 2008;57:1441-1447.