Younes, RamyCaviglia, Gian PaoloGovaere, OlivierRosso, ChiaraArmandi, AngeloSanavia, TizianaPennisi, GraziaLiguori, AntonioFrancione, PaoloGallego-Duran, RocioAmpuero, JavierGarcia Blanco, Maria JAller, RocioTiniakos, DinaBurt, AlastairDavid, EzioVecchio, Fabio MMaggioni, MarcoCabibi, DanielaPareja, Maria JesusZaki, Marco Y WGrieco, AntonioFracanzani, Anna LValenti, LucaMiele, LucaFariselli, PieroPetta, SalvatoreRomero-Gomez, ManuelAnstee, Quentin MBugianesi, Elisabetta2025-01-072025-01-072021-06-03Younes R, Caviglia GP, Govaere O, Rosso C, Armandi A, Sanavia T, et al. Long-term outcomes and predictive ability of non-invasive scoring systems in patients with non-alcoholic fatty liver disease. J Hepatol. 2021 Oct;75(4):786-794.https://hdl.handle.net/10668/27222Non-invasive scoring systems (NSS) are used to identify patients with non-alcoholic fatty liver disease (NAFLD) who are at risk of advanced fibrosis, but their reliability in predicting long-term outcomes for hepatic/extrahepatic complications or death and their concordance in cross-sectional and longitudinal risk stratification remain uncertain. The most common NSS (NFS, FIB-4, BARD, APRI) and the Hepamet fibrosis score (HFS) were assessed in 1,173 European patients with NAFLD from tertiary centres. Performance for fibrosis risk stratification and for the prediction of long-term hepatic/extrahepatic events, hepatocarcinoma (HCC) and overall mortality were evaluated in terms of AUC and Harrell's c-index. For longitudinal data, NSS-based Cox proportional hazard models were trained on the whole cohort with repeated 5-fold cross-validation, sampling for testing from the 607 patients with all NSS available. Cross-sectional analysis revealed HFS as the best performer for the identification of significant (F0-1 vs. F2-4, AUC = 0.758) and advanced (F0-2 vs. F3-4, AUC = 0.805) fibrosis, while NFS and FIB-4 showed the best performance for detecting histological cirrhosis (range AUCs 0.85-0.88). Considering longitudinal data (follow-up between 62 and 110 months), NFS and FIB-4 were the best at predicting liver-related events (c-indices>0.7), NFS for HCC (c-index = 0.9 on average), and FIB-4 and HFS for overall mortality (c-indices >0.8). All NSS showed limited performance (c-indices 0.7), NFS for HCC (c-index = 0.9 on average), and FIB-4 and HFS for overall mortality (c-indices >0.8). All NSS showed limited performance (c-indices 0.8). All NSS showed limited performance (c-indices Overall, NFS, HFS and FIB-4 outperformed APRI and BARD for both cross-sectional identification of fibrosis and prediction of long-term outcomes, confirming that they are useful tools for the clinical management of patients with NAFLD at increased risk of fibrosis and liver-related complications or death. Non-invasive scoring systems are increasingly being used in patients with non-alcoholic fatty liver disease to identify those at risk of advanced fibrosis and hence clinical complications. Herein, we compared various non-invasive scoring systems and identified those that were best at identifying risk, as well as those that were best for the prediction of long-term outcomes, such as liver-related events, liver cancer and death.enAPRIBARDFIB-4HFSNASHNFSNSSAdultArea Under CurveCross-Sectional StudiesFemaleHumansLiverMaleMiddle AgedNon-alcoholic Fatty Liver DiseasePredictive Value of TestsPrognosisROC CurveReproducibility of ResultsResearch DesignSeverity of Illness IndexTimeresearch article34090928Restricted AccessFibrosisRiesgoPacientesEnfermedad del hígado graso no alcohólicoMortalidadNeoplasias hepáticasMortalidad10.1016/j.jhep.2021.05.0081600-0641