Identifying patients with NASH and determining their degree of fibrosis are critical for optimal care¹

Advances in noninvasive tests (NITs) may help to identify and monitor patients with NASH in the clinical practice setting^1-3

NITs help to quantify and assess hepatic steatosis, disease activity, and/or fibrosis and have the potential to assist with patient identification, monitoring, and predicting long-term outcomes^1,4,5
When used in combination or sequentially, NITs can improve accuracy by reducing the number of indeterminate results^4,6
A liver biopsy may be used to confirm diagnosis and can provide helpful information¹

Using a structured and systematic approach, you can identify patients with NASH and significant fibrosis* *Fibrosis stage F2 or F3 as defined histologically.^1,11 in various practice settings¹

NAFLD/NASH is largely asymptomatic, and optimal timing of treatment is dependent on accurate staging of fibrosis risk¹
Identifying patients with significant fibrosisFibrosis stage F2 or F3 as defined histologically.^1,11 in a timely, evidence-based, and accessible manner is critical so that patients can receive the appropriate management¹
Below is one approach to evaluate risk and identify patients who may require active management¹

Patient identification clinical pathway^1,2,7

Identify patients at risk

Two or more metabolic risk factors, type 2 diabetes, steatosis on any imaging modality, or elevated aminotransferases

Review patient history

Laboratory tests, excessive alcohol intake, CBC, liver function tests

Diagnose and stratify risk

One or more NITs can be performed to assess the likelihood of NASH and significant fibrosis. These can include fibrosis scores and tests like FIB-4 and ELF, and liver imaging like Fibroscan, MRI-PDFF, and MRE. Biopsy may provide helpful information in certain circumstances.

Low risk

FIB-4: <1.3
VCTE: <8 kPa
ELF: <7.7

Intermediate risk

FIB-4: 1.3-2.67
VCTE: 8-12 kPa
ELF: 7.7-9.8

High risk

FIB-4: >2.67
VCTE: >12 kPa
ELF: >9.8

Patients identified as intermediate or high risk (or fibrosis stage F2-F3) may benefit from being actively monitored and managed by a specialist

Looking for fibrosis?

US NAFLD/NASH guidance and guidelines discuss various NITs that can be used^1,2,8

Imaging and scanning technologies

Vibration-controlled transient elastography^1,2,8,9
Magnetic resonance elastography^1,2,8,9
Magnetic resonance imaging—estimated proton density fat fraction^2,8,9

Standard liver tests

Fibrosis-4 index^1,2,8,9
NAFLD fibrosis score^2,8,10
Aspartate aminotransferase to platelet ratio index^1,2

Proprietary liver tests

Enhanced liver fibrosis panel^2,8
Hepascore²
FibroSure/FibroTest^2,9
FibroMeter²

*Fibrosis stage F2 or F3 as defined histologically.^1,11
CBC=complete blood count; ELF=enhanced liver fibrosis; FIB-4=Fibrosis-4 index; kPa=kilopascals; MRE=magnetic resonance elastography; MRI-PDFF=magnetic resonance imaging estimated proton density fat; NAFLD=nonalcoholic fatty liver disease; NASH=nonalcoholic steatohepatitis; VCTE=vibration-controlled transient elastography.

Find additional details about NASH from other established resources

Identifying patients with NASH and determining their degree of fibrosis are critical for optimal care1

Advances in noninvasive tests (NITs) may help to identify and monitor patients with NASH in the clinical practice setting1-3

Using a structured and systematic approach, you can identify patients with NASH and significant fibrosis* *Fibrosis stage F2 or F3 as defined histologically.1,11 in various practice settings1