A systematic review published in the Journal of Clinical Gastroenterology supported the usage of non-alcoholic fatty liver disease (NAFLD) fibrosis score, fibrosis-4, and vibration-controlled transient elastography within sequential algorithms for attaining diagnostic precision for advanced fibrosis in people suffering from NAFLD.

Shaya Noorian et al. aimed to systematically review accuracy of sequential algorithms to evaluate advanced fibrosis in people having NAFLD. Databases such as Embase and PubMed were searched for identifying studies that investigated diagnostic characteristics of sequential noninvasive tests algorithms in NAFLD.

Among eight studies fulfilling inclusion criteria, 48 algorithms were explored in 6741 people. The average sensitivity, specificity, positive predictive values, negative predictive values, and proportion of indeterminate values for the incorporated algorithms are shown in Table 1:

In total, 4 algorithms attained specificities in the top quartile (≥98.7%) with <25% indeterminate values, and 6 algorithms attained sensitivities in the top quartile (≥86.3%) with <25% indeterminate values. The algorithms incorporated the combinations of vibration-controlled transient elastography, fibrosis-4, and NAFLD fibrosis score.

Sequential algorithms might also increase the specificities of single noninvasive tests, though resulting positive predictive values might not be high enough to avert the requirement for liver biopsy, concluded the study authors.