Blood markers vs transient elastography for liver stiffness and steatosis in metabolic dysfunction-associated steatotic liver disease

Table 1 Frequencies of liver stiffness from FibroScan

E	Counts	% of total
F0	113	37.7
F1	30	10.0
F2	38	12.7
F3	15	5.0
F4	104	34.6

Table 2 Baseline characteristics of participants, n (%)

Characteristic	Total (n = 300)	Male (n = 237)	Female (n = 63)
Age (years)	52.4 ± 11.2	52.1 ± 11.0	53.2 ± 11.8
BMI (kg/m2)	28.7 ± 4.3	28.9 ± 4.1	28.1 ± 4.8
Diabetes mellitus	187 (62.3)	149 (62.9)	38 (60.3)
Hypertension	203 (67.7)	162 (68.4)	41 (65.1)
Dyslipidemia	245 (81.7)	195 (82.3)	50 (79.4)

BMI: Body mass index.

Table 3 Comparison of different indices by gender

Indices	Male	Female	P value
FIB-4	1.64 (0.83-3.15)	1.59 (0.94-2.54)	0.560
NLR	1.90 (1.54-2.81)	2.19 (1.12-3.21)	0.632
PLR	142.5 (98.2-189.7)	139.7 (102.4-178.3)	0.781
NPAR	14.13 (12.20-17.14)	14.04 (11.80-16.56)	0.793
APRI	1.23 (0.25-2.21)	1.09 (0.22-1.96)	0.297
CAP	270.00 (223-302)	273.00 (243.00-302.00)	0.642
Liver stiffness	9.30 (5.40-26.80)	4.80 (4.40-7.60)	0.002

FIB-4: Fibrosis index based on four factors; APRI: Aspartate transaminase to platelet ratio index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; NPAR: Neutrophil percentage-to-albumin ratio; CAP: Controlled attenuation parameter.

Table 4 Diagnostic performance of the indices for the differentiation of F3 and F4 from lower stages

Indices	AUC	P value	Sensitivity	Specificity	PPV (%)	NPV (%)	DA (%)
FIB-4	0.806	0.000	0.692	0.804	72.97	77.36	75.63
APRI	0.772	0.000	0.820	0.627	62.75	82.05	71.21
NLR	0.540	0.512	0.462	0.706	54.55	63.16	60.00
PLR	0.301	0.001	0.051	0.980	66.67	57.47	58.43
NPAR	0.673	0.005	0.615	0.745	64.86	71.7	68.88

FIB-4: Fibrosis index based on four factors; APRI: Aspartate transaminase to platelet ratio index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; NPAR: Neutrophil percentage-to-albumin ratio; AUC: Area under the curve; PPV: Positive predictive value; NPV: Negative predictive value; DA: Diagnostic accuracy.

Table 5 Diagnostic performance of the indices for liver stiffness measurement

Indices	AUC	P value	Sensitivity	Specificity	PPV (%)	NPV (%)
FIB-4	0.806	0	0.692	0.804	72.97	77.36
APRI	0.772	0	0.82	0.627	62.75	82.05
NLR	0.54	0.512	0.462	0.706	54.55	63.16
PLR	0.301	0.001	0.051	0.98	66.67	57.47
NPAR	0.673	0.005	0.615	0.745	64.86	71.7

FIB-4: Fibrosis index based on four factors; APRI: Aspartate transaminase to platelet ratio index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; AUC: Area under the curve; PPV: Positive predictive value; NPV: Negative predictive value.

Table 6 Diagnostic performance of the indices for controlled attenuation parameter

Indices	AUC	P value	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
FIB-4	0.516	0.769	40.54	72.09	71.43	41.33
APRI	0.566	0.236	50.08	32.56	67.42	50
NPAR	0.467	0.553	16.22	97.67	92.31	40.38
NLR	0.474	0.57	45.34	92.77	91.58	40.38
PLR	0.54	0.388	58.14	54.05	59.52	52.63

FIB-4: Fibrosis index based on four factors; APRI: Aspartate transaminase to platelet ratio index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; NPAR: Neutrophil percentage-to-albumin ratio; AUC: Area under the curve; PPV: Positive predictive value; NPV: Negative predictive value.

Table 7 Cut-off validation against established thresholds

Marker	Established cut-off	Our cut-off	Clinical utility
FIB-4	> 1.45 (rule-out)	> 1.42	Equivalent rule-out
APRI	> 0.7 (significant)	> 0.68	Validated threshold
PLR	Novel marker	> 142.5	Exploratory
NPAR	Novel marker	> 14.13	Exploratory

FIB-4: Fibrosis index based on four factors; APRI: Aspartate transaminase to platelet ratio index; PLR: Platelet-to-lymphocyte ratio; NPAR: Neutrophil percentage-to-albumin ratio.