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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
BMC Gastroenterol. 2012; 12: 2.
Published online Jan 5, 2012. doi:  10.1186/1471-230X-12-2
PMCID: PMC3266187
Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population
Yoshio Sumida,1 Masato Yoneda,2 Hideyuki Hyogo,3 Yoshito Itoh,4 Masafumi Ono,corresponding author5 Hideki Fujii,6 Yuichiro Eguchi,7 Yasuaki Suzuki,8 Noriaki Aoki,9 Kazuyuki Kanemasa,1 Koji Fujita,2 Kazuaki Chayama,3 Toshiji Saibara,5 Norifumi Kawada,6 Kazuma Fujimoto,7 Yutaka Kohgo,8 Toshikazu Yoshikawa,4 and Takeshi Okanoue10, Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)
1Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
2Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
3Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
4Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
5Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
6Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
7Department of Internal Medicine, Saga Medical School, Saga University, Saga, Japan
8Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan
9School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
10Hepatology Center, Saiseikai Suita Hospital, Suita, Japan
corresponding authorCorresponding author.
Yoshio Sumida: sumida/at/; Masato Yoneda: yoneda/at/; Hideyuki Hyogo: hidehyogo/at/; Yoshito Itoh: yitoh/at/; Masafumi Ono: onom/at/; Hideki Fujii: rolahideki/at/; Yuichiro Eguchi: eguchiyu/at/; Yasuaki Suzuki: yasuaki/at/; Noriaki Aoki: cio/at/; Kazuyuki Kanemasa: kanemasa/at/; Koji Fujita: kfujita/at/; Kazuaki Chayama: chayama/at/; Toshiji Saibara: saibarat/at/; Norifumi Kawada: kawadanori/at/; Kazuma Fujimoto: fujimotk/at/; Yutaka Kohgo: yk1950/at/; Toshikazu Yoshikawa: toshi/at/; Takeshi Okanoue: okanoue/at/
Received April 22, 2011; Accepted January 5, 2012.
A reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) is expected to be useful for evaluating hepatic fibrosis. We validated the performance of FIB4 index in a Japanese cohort with NAFLD.
The areas under the receiver operating characteristic curves (AUROC) for FIB4 and six other markers were compared, based on data from 576 biopsy-proven NAFLD patients. Advanced fibrosis was defined as stage 3-4 fibrosis. FIB4 index was assessed as: age (yr) × AST (IU/L)/(platelet count (109/L) × √ALT (IU/L))
Advanced fibrosis was found in 64 (11%) patients. The AUROC for FIB4 index was superior to those for the other scoring systems for differentiating between advanced and mild fibrosis. Only 6 of 308 patients with a FIB4 index below the proposed low cut-off point (< 1.45) were under-staged, giving a high negative predictive value of 98%. Twenty-eight of 59 patients with a FIB4 index above the high cut-off point (> 3.25) were over-staged, giving a low positive predictive value of 53%. Using these cutoffs, 91% of the 395 patients with FIB-4 values outside 1.45-3.25 would be correctly classified. Implementation of the FIB4 index in the Japanese population would avoid 58% of liver biopsies.
The FIB4 index was superior to other tested noninvasive markers of fibrosis in Japanese patients with NAFLD, with a high negative predictive value for excluding advanced fibrosis. The small number of cases of advanced fibrosis in this cohort meant that this study had limited power for validating the high cut-off point.
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