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Summary
Serum-based and elastography tests accurately exclude advanced fibrosis and cirrhosis in patients
with NAFLD. However, the prediction of these endpoints is modest and both types of non-invasive
modalities suffer from indeterminate scores or unsuccessful acquisition in approximately one quarter
of patients (Table 4). Serum tests are widely validated and predict future liver related morbidity and
mortality in NAFLD patients, whereas elastography-based tests offer the promise of increased accuracy.
Clarification of appropriate cut-offs and investigating dynamic changes over time are required.

Table 4. Diagnostic utility of non-invasive predictors of fibrosis in NAFLD.

Test AUROC AUROC Indeterminate Externally Prognostic Dynamic
for F3-4 1 for F4 % for F3-4 2 validated

Serum-based tests 0.75
0.75
APRI 0.74 0.82 Nil ++++ ++ Unknown
0.86 Nil ++++ + Unknown
BARD 0.78 0.94 14% + Unknown Unknown
0.86 30% ++++ ++ Unknown
ELF 0.90 0.91 2.5% + Unknown Unknown
- 33% ++ ++ +
FIB-4 0.86 Nil + Unknown Unknown
0.98 24-40% ++++ +++ Unknown
Fibrometer 0.94 0.89
0.95
Fibrotest 0.80

Hepascore 0.81

NFS 0.85

Elastography

ARFI 0.98 22% ++ Unknown Unknown
Unknown + Unknown Unknown
MRE 0.92 25% +++ Unknown Unknown

TE 0.93

1 AUROC values from meta-analysis or largest independent validation study if available [5, 16].

2The criteria for ‘Indeterminate’ differ between studies and are thus not directly comparable. Unsuccessful
elastography acquisition included as ‘indeterminate’.

The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 29