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Validation and Performance of FibroScan®-AST (FAST) Score on a Brazilian Population with Nonalcoholic Fatty Liver Disease

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Abstract

Background and Aim

FAST score has a good performance for diagnosing the composite of NASH + NAS ≥ 4 + F ≥ 2. However, it has not been evaluated in Latin American individuals with nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the performance of the FAST score in a Brazilian NAFLD population.

Methods

Cross-sectional study was held in ≥ 18 years NAFLD patients diagnosed by ultrasonography and submitted to liver biopsy (LB). Liver stiffness (LSM) and CAP measurements were performed with FibroScan®, using M (BMI < 32 kg/m2) or XL probes. Area under receiver operating characteristic (AUROC) curves were calculated as well as sensitivity (S), specificity (Spe), positive predictive value (VPP) and negative predictive value (NPV) for the previously established FAST score cut-offs.

Results

Among 287 patients included (75% female; mean age 55 ± 10 years), NASH + NAS ≥ 4 + F ≥ 2 was reported in 30% of LB. For the FAST cut-off of 0.35, the S and NPV to rule out NASH + NAS ≥ 4 + F ≥ 2 were 78.8% and 87.8%, respectively. Regarding the cut-off of 0.67, the Spe and PPV to rule-in NASH + NAS ≥ 4 + F ≥ 2 were 89.1%, 61.8%, respectively. The AUROC of FAST for all included patients was 0.78 (95% CI 0.72–0.84) and for those with ≥ 32 kg/m2 was 0.81 (95% CI 0.74–0.88).

Conclusion

FAST score has a good performance in a Brazilian NAFLD population, even in patients with higher BMI when the XL probe is adopted. Therefore, FAST can be used as a noninvasive screening tool mainly for excluding the diagnosis of progressive NASH, reducing the number of unnecessary liver biopsies.

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Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Steatohepatitis

TE:

Transient elastography

CAP:

Controlled Attenuation Parameter

LSM:

Liver stiffness measurement

AST:

Aspartate aminotransferase

FAST score:

FibroScan®-AST

PPV:

Positive predictive value

NPV:

Negative predictive value

HIV:

Human immunodeficiency virus

HCV:

Hepatitis C virus

HBV:

Hepatitis B virus

ICF:

Informed consent form

BMI:

Body mass index

ALT:

Alanine aminotransferase

GGT:

Gammaglutamil transferase

kPa:

Kilopascal

dB/m:

Decibel/meter

OR:

Odds ratios

AUROC:

Area under receiver operating characteristic

T2DM:

Type 2 diabetes

SAH:

Systemic arterial hypertension

S:

Sensitivity

Spe:

Specificity

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Funding

This work was supported by funding from Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico, (CNPq), Brazil.

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Authors and Affiliations

  1. Hepatology Unit - Clementino Fraga Filho University Hospital – School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil

    Ana Carolina Cardoso, Nathalie Carvalho Leite, Fernanda Luiza Calçado, Claudia Cravo, Renata de Mello Perez & Cristiane A. Villela-Nogueira

  2. Gastroenterology and Hepatology Unit, Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil

    Cristiane Valle Tovo & Gabriela Perdomo Coral

  3. Division of Gastroenterology, Hepatology Section, Federal University of São Paulo, São Paulo, Brazil

    Ibrahim A. El Bacha, Glauco Navas Sammarco, Roberto José Carvalho Filho & Edison Roberto Parise

  4. Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Ronir Raggio Luiz

Authors
  1. Ana Carolina Cardoso
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  2. Cristiane Valle Tovo
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  13. Cristiane A. Villela-Nogueira
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Contributions

Cristiane A. Villela-Nogueira and Ana Carolina Cardoso contributed to the study conception and design. Material preparation and data collection were performed by Ana Carolina Cardoso, Cristiane Valle Tovo, Nathalie Carvalho Leite, Ibrahim A El Bacha, Fernanda Luiza Calçado, Gabriela Perdomo Coral, Glauco Navas Sammarco, Claudia Cravo, Roberto José Carvalho Filho, Renata de Mello Perez, Edison Roberto Parise and Cristiane A. Villela-Nogueira. Statistical analysis was performed by Ronir Raggio Luiz and Cristiane A. Villela-Nogueira. The first draft of the manuscript was written by Ana Carolina Cardoso, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cristiane A. Villela-Nogueira.

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Conflict of interest

The authors have nothing to disclose.

Ethics approval

All procedures performed in this study were following the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments. The local Ethics Committee (Hospital Universitário Clementino Fraga Filho) approved the study (CAAE No. 38752414.7.0000.5257).

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Informed consent was obtained from all individual participants included in the study.

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Cardoso, A.C., Tovo, C.V., Leite, N.C. et al. Validation and Performance of FibroScan®-AST (FAST) Score on a Brazilian Population with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 67, 5272–5279 (2022). https://doi.org/10.1007/s10620-021-07363-x

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