Gut Liver.
2024 Mar;18(2):283-293. 10.5009/gnl230128.
Proposal of a Novel Serological Algorithm Combining FIB-4 and Serum M2BPGi for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease
- Affiliations
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- 1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
- 2Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- 3Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- 4Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
- 5Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Korea
- 6Liver Center, Pusan National University Yangsan Hospital, Yangsan, Korea
- 7Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
- 8Division of Gastroenterology, Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
- 9Department of Information Statistics, Andong National University, Andong, Korea
- KMID: 2553837
- DOI: http://doi.org/10.5009/gnl230128
Abstract
- Background/Aims
Noninvasive methods have become increasingly critical in the diagnosis of fibrosis in chronic liver diseases. Herein, we compared the diagnostic performance of serum Mac2 binding protein glycosylation isomer (M2BPGi) and other serological panels for fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and proposed an improved two-step diagnostic algorithm for advanced fibrosis.
Methods
We enrolled 231 patients diagnosed with NAFLD who underwent a liver biopsy. We subsequently evaluated the diagnostic performance of serological panels, including serum M2BPGi, a fibrosis index based on four factors (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS), in predicting the stage of liver fibrosis. We then constructed a two-step algorithm to better differentiate advanced fibrosis.
Results
The areas under the receiver operating characteristic curves of serum M2BPGi, FIB-4, APRI, and NFS for advanced fibrosis (≥F3) were 0.823, 0.858, 0.779, and 0.827, respectively. To reduce the performance of unnecessary liver biopsy, we propose a two-step algorithm using FIB-4 as an initial diagnostic tool and serum M2BPGi (≥0.6) as an additional diagnostic method for patients classified as intermediate (23%). Using the proposed algorithm, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.812, 0.814, 0.814, 0.600, and 0.927, respectively.
Conclusions
Serum M2BPGi is a simple and effective test for advanced fibrosis in patients with NAFLD. Application of the two-step algorithm based on FIB-4 and M2BPGi proposed here can improve diagnostic performance and reduce unnecessary tests, making diagnosis easily accessible, especially in primary medical centers.
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