Can Noninvasive Tests Reduce the Need for Liver Biopsy? a Cross-Sectional Diagnostic Accuracy Study Assessing Nfs, Fib-4, Apri, Bard, Baat, Api, and Aar for Advanced Fibrosis in Masld Patients in Iran Publisher



Salehi A M ; Salehi H ; Sadeghi A ; Hasanzarrini M ; Khazaei S ; Mohammadi H A ; Naini M A
Source: International Journal of Clinical Practice Published:2026

Abstract

Background: Liver fibrosis is a metabolic dysfunction–associated steatotic liver disease (MASLD) complication. A dependable and cost-effective noninvasive marker for hepatic fibrosis is needed in patients with MASLD. We aimed to evaluate and compare the diagnostic accuracy of the APRI, FIB-4, NFS, BARD score, BAAT score, API, and AAR score instruments in detecting advanced liver fibrosis and cirrhosis among Iranian subjects with MASLD. Methods: This retrospective cross-sectional diagnostic accuracy study was conducted on 301 patients with biopsy-confirmed MASLD recruited from three tertiary care centers in Iran between 2022 and 2024. Clinical, laboratory, and histopathological data were collected. Receiver operating characteristic (ROC) curves were created to identify optimal cutoff points using the Youden index, along with calculations for sensitivity, specificity, and predictive values. Results: A total of 301 patients (mean age: 42.83 ± 11.13 years; 63.12% male) were included. Advanced fibrosis (Stages 3–4) was present in 23.59% of patients. APRI was able to detect advanced fibrosis levels (Stage 3 and cirrhosis) with an area under the ROC curve (AUROC) of 0.930. In comparison, FIB-4 identified advanced fibrosis with an AUROC of 0.897, NFS achieved an AUROC of 0.871, and the BARD score had an AUROC of 0.688. Likewise, the BAAT score also recorded an AUROC of 0.579, while the AAR score provided an AUROC of 0.641, and the API score also showed an AUROC of 0.807. Conclusion: In this study, the APRI, FIB-4, and NFS tests demonstrated the highest predictive power for advanced liver fibrosis in the Iranian population. Copyright © 2026 Amir Mohammad Salehi et al. International Journal of Clinical Practice published by John Wiley & Sons Ltd.