Aspartate transaminase to platelet ratio index (APRI) but not FIB-5 or FIB-4 is accurate in ruling out significant fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) in an urban slum-dwelling population

Background and aims Non-invasive assessment of fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is challenging, especially in resource-limited settings. MR or transient elastography and many patented serum scores are costly and not widely available. There are limited data on accuracy of serum-based fibrosis scores in urban slum-dwelling population, which is a unique group due to its dietary habits and socioeconomic environment. We did this study to compare the accuracy of serum-based fibrosis scores to rule out significant fibrosis (SF) in this population. Methods Histological and clinical data of 100 consecutive urban slum-dwelling patients with NAFLD were analysed. Institutional ethics committee permission was taken. Aspartate transaminase (AST) to platelet ratio index (APRI), fibrosis-4 index (FIB-4) and FIB-5 scores were compared among those with non-significant fibrosis (METAVIR; F0 to F1; n= 73) and SF (METAVIR; F2 to F4; n= 27). Results AST (IU/mL) (68.3 +/- 45.2 vs 23.9 +/- 10.9; p<0.0001), alanine transaminase (IU/mL) (76.4 +/- 36.8 vs 27.9 +/- 11.4; p<0.0001), FIB-4 (2.40 +/- 2.13 vs 0.85 +/- 0.52; p<0.0001) and APRI (1.18 +/- 0.92 vs 0.25 +/- 0.16; p<0.0001) were higher and platelets (100 000/mm(3)) (1.8 +/- 0.8 vs 2.6 +/- 0.7; p<0.0001), albumin (g/dL) (3.4 +/- 0.50 vs 3.7 +/- 0.4; p<0.0001), alkaline phosphatase (IU/L) (60.9 +/- 10.2 vs 76.4 +/- 12.9; p<0.0001) and FIB-5 (-1.10 +/- 6.58 vs 3.79 +/- 4.25; p<0.0001) were lower in SF group. APRI had the best accuracy (area under the receiver operating characteristic curve=0.95) followed by FIB-4 (0.78) and FIB-5 (0.75) in ruling out SF. Conclusions APRI but not FIB-5 or FIB-4 is accurate in ruling out SF in patients with NAFLD in an urban slum-dwelling population.