Multicenter validation of FIB-6 as a novel machine learning non-invasive score to rule out liver cirrhosis in biopsy-proven MAFLD
Open accessAbstract
BACKGROUND AND AIMS: We previously developed and validated a non-invasive diagnostic index based on routine laboratory parameters for predicting the stage of hepatic fibrosis in patients with chronic hepatitis C (CHC) called FIB-6 through machine learning with random forests algorithm using retrospective data of 7238 biopsy-proven CHC patients. Our aim is to validate this novel score in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). METHOD: Performance of the new score was externally validated in cohorts from one site in Egypt (n = 674) and in 5 different countries (n = 1798) in Iran, KSA, Greece, Turkey and Oman. Experienced pathologists using METAVIR scoring system scored the biopsy samples. Results were compared with FIB-4, APRI, and AAR. RESULTS: A total of 2472 and their liver biopsy results were included, using the optimal cutoffs of FIB-6 indicated a reliable performance in diagnosing cirrhosis, severe fibrosis, and significant fibrosis with sensitivity = 70.5%, specificity = 62.9%. PPV = 15.0% and NPV = 95.8% for diagnosis of cirrhosis. For diagnosis of severe fibrosis (F3 and F4), the results were 86.5%, 24.0%, 15.1% and 91.9% respectively, while for diagnosis of significant fibrosis (F2, F3 and F4), the results were 87.0%, 16.4%, 24.8% and 80.0%). Comparing the results of FIB-6 rule-out cutoffs with those of FIB-4, APRI, and AAR, FIB-6 had the highest sensitivity and NPV (97.0% and 94.7%), as compared to FIB-4 (71.6% and 94.7%), APRI (36.4% and 90.7%), and AAR (61.2% and 90.9%). CONCLUSION: FIB-6 score is an accurate, simple, NIT for ruling out advanced fibrosis and liver cirrhosis in patients with MAFLD.
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Machine-learning techniques have been applied to develop optimised scores from multi-parametric inputs.
“Recently, machinelearning techniques have been applied to develop optimised scores from multi-parametric inputs.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [142]
Derived scores such as FIB-6 cannot be defined in closed formulae but may have improved diagnostic value.
“Derived scores (such as FIB-6) cannot be de fi ned in closed formulae but may have improved diagnostic value.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [142]
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- Authors
- Anushiravani, A., Alswat, K., Dalekos, G. N., Zachou, K., Örmeci, N., Al-Busafi, S., Abdo, A., Sanai, F., Mikhail, N. N., Soliman, R., & Shiha, G.
- Affiliations
- Shariati Hospital (IR)
- King Saud University (SA)
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- University Hospital of Larissa (GR)
- Department of Internal Medicine, Gastroenterology and Hepatology İstanbul Health and Technology University, Istanbul, Türkiye
- Department of Medicine, Division of Gastroenterology and Hepatology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
- Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Assiut University (EG)
- Gastroenterology and Hepatology Department, Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura
- Mansoura University (EG)
- Corresponding author
- Shiha, Gamal
- Venue
- European Journal of Gastroenterology & Hepatology
- Published
- 2023-09-05
- Volume
- 35
- Issue
- 11
- Pages
- 1284-1288
- ISSN
- 0954-691X (ISSN-L)
- OpenAlex
- W4386592742
- Cited by
- 14
- References
- 25
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- Locations
- European Journal of Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Istanbul Health and Technology University Institutional Repository (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, liver cirrhosis, liver fibrosis staging, non-invasive fibrosis scores, METAVIR scoring, FIB-4, APRI, AAR, random forest, external validation, multicenter validation
- MeSH terms
- Aspartate Aminotransferases, Biopsy, Humans, Liver, Liver Cirrhosis, Retrospective Studies, Severity of Illness Index, Biomarkers, Non-alcoholic Fatty Liver Disease
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