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    Multicenter validation of FIB-6 as a novel machine learning non-invasive score to rule out liver cirrhosis in biopsy-proven MAFLD
    (Lippincott Williams & Wilkins, 2023) Anushiravani, Amir; Alswat, Khalid; Dalekos, George N.; Zachou, Kalliopi; Örmeci, Necati; Al-Busafi, Said; Abdo, Ayman; Sanai, Faisal; Mikhail, Nabiel Nh; Soliman, Riham; Shiha, Gamal
    Background and aims: We previously developed and validated a non-invasive diagnostic index based on routine laboratory parameters for predicting the stage of hepatic fibrosis in patients with chronic hepatitis C (CHC) called FIB-6 through machine learning with random forests algorithm using retrospective data of 7238 biopsy-proven CHC patients. Our aim is to validate this novel score in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Method: Performance of the new score was externally validated in cohorts from one site in Egypt (n = 674) and in 5 different countries (n = 1798) in Iran, KSA, Greece, Turkey and Oman. Experienced pathologists using METAVIR scoring system scored the biopsy samples. Results were compared with FIB-4, APRI, and AAR. Results: A total of 2472 and their liver biopsy results were included, using the optimal cutoffs of FIB-6 indicated a reliable performance in diagnosing cirrhosis, severe fibrosis, and significant fibrosis with sensitivity = 70.5%, specificity = 62.9%. PPV = 15.0% and NPV = 95.8% for diagnosis of cirrhosis. For diagnosis of severe fibrosis (F3 and F4), the results were 86.5%, 24.0%, 15.1% and 91.9% respectively, while for diagnosis of significant fibrosis (F2, F3 and F4), the results were 87.0%, 16.4%, 24.8% and 80.0%). Comparing the results of FIB-6 rule-out cutoffs with those of FIB-4, APRI, and AAR, FIB-6 had the highest sensitivity and NPV (97.0% and 94.7%), as compared to FIB-4 (71.6% and 94.7%), APRI (36.4% and 90.7%), and AAR (61.2% and 90.9%). Conclusion: FIB-6 score is an accurate, simple, NIT for ruling out advanced fibrosis and liver cirrhosis in patients with MAFLD.
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    Validation of FIB-6 score in assessment of liver fibrosis in chronic hepatitis B
    (Wolters Kluwer Health, 2024) Alswat, Khalid; Soliman, Riham; Mikhail, Nabiel N. H.; Örmeci, Necati; Dalekos, George N.; Derbala, Moutaz F. M.; Al-Busafi, Said Ahmed; Hamoudi, Waseem; Shiha, Gamal
    Background: We recently developed a simple novel index called fibrosis 6 (FIB‑6) using machine learning data analysis. We aimed to evaluate its performance in the diagnosis of liver fibrosis and cirrhosis in chronic hepatitis B (CHB). Methods: A retrospective observational analysis of data was obtained from seven countries(Egypt, Kingdom of Saudi Arabia (KSA), Turkey, Greece, Oman, Qatar, and Jordan) of CHB patients. The inclusion criteria were receiving an adequate liver biopsy and a complete biochemical and hematological data. The diagnostic performance analysis of the FIB‑6 index was conducted and compared with other non‑invasive scores. Results: A total of 603 patients were included for the analysis; the area under the receiver operating characteristic curve (AUROC) of FIB‑6 for the discrimination of patients with cirrhosis (F4), compensated advanced chronic liver disease (cACLD) (F3 and F4), and significant fibrosis (F2–F4) was 0.854, 0.812, and 0.745, respectively. The analysis using the optimal cut‑offs of FIB‑6 showed a sensitivity of 70.9%, specificity of 84.1%, positive predictive value (PPV) of 40.3%, and negative predictive value (NPV) of 95.0% for the diagnosis of cirrhosis. For the diagnosis of cACLD, the results were 71.5%, 69.3%, 40.8%, and 89.2%, respectively, while for the diagnosis of significant fibrosis, the results were 68.3%, 67.5%, 59.9%, and 75.0%, respectively. When compared to those of fibrosis 4 (FIB‑4) index, aspartate aminotransferase (AST)‑to‑platelet ratio index (APRI), and AST‑to‑alanine aminotransferase (ALT) ratio (AAR), the AUROC for the performance of FIB‑6 was higher than that of FIB‑4, APRI, and AAR in all fibrosis stages. FIB‑6 gave the highest sensitivity and NPV (89.1% and 92.4%) in ruling out cACLD and cirrhosis, as compared to FIB‑4 (63.8% and 83.0%), APRI (53.9% and 86.6%), and AAR (47.5% and 82.3%), respectively. Conclusions: The FIB‑6 index could be used in ruling out cACLD, fibrosis, and cirrhosis with good reliability.