Comparative Diagnostic Accuracy of FIB-4, APRI, and NAFLD Fibrosis Score for Detecting Advanced Fibrosis in Patients with Chronic Liver Disease

Abstract

Background: Chronic liver disease is a situation where the presence of extensive hepatic fibrosis is a clinically important threshold associated with future cirrhosis, portal venous hypertension, liver failure events, hepatocelluar carcinoma and the death related to liver diseases. Although transient elastography can give a good non-invasive assessment of fibrosis load, its restricted use in many clinical contexts means that routine laboratory-based fibrosis scores may be useful for initial risk stratification.

Objective: To assess how accurately FIB-4, APRI, and the NAFLD Fibrosis Score detect advanced liver fibrosis in adult patients with chronic liver disease.

Methods: A cross-sectional diagnostic accuracy study was carried out from June 2024 to September 2025 at Gambat Medical College, Gambat, Sindh, and Jinnah Postgraduate Medical Centre, Karachi. The analysis included 120 adults with confirmed chronic liver disease. Patient demographics, clinical details, liver biochemical markers, and haematological parameters were collected using a structured recording method. The three non-invasive fibrosis indices, FIB-4, APRI, and the NAFLD Fibrosis Score, were calculated using their standard formulas. Transient elastography was used as the reference method for classifying advanced fibrosis. Diagnostic performance was assessed for each score by calculating sensitivity, specificity, predictive values, overall accuracy, correct classification, and ROC curve-based discrimination.

Results: Advanced fibrosis was identified by transient elastography in 42 of 120 participants (35.0%). FIB-4 had the best diagnostic profile with sensitivity of 80.9% and specificity of 76.9% and accuracy of 78.3%, negative predictive value of 88.2% and AUC of 0.84. The NAFLD Fibrosis Score had intermediate level discrimination (AUC = 0.79) while APRI had the lowest of the three indices (AUC = 0.73).

Conclusion: Among the three serum-derived fibrosis indices evaluated, FIB-4 performed best for recognising advanced fibrosis in chronic liver disease. The simplicity and good negative predictive value lend to its use as a primary screening technique, particularly within centres where elastography is not commonly used.