Comparison of Novel Fibrosis Index (NFI) with Aspartate aminotransferase to platelet ratio index (APRI) in Type II Diabetes mellitus patients with Non alcoholic fatty liver disease and fibrosis (NAFLD).

With India being the "Diabetes capital of the world", nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of liver dysfunction. Varied prevalence of this disease in Type II Diabetics indicate variability in NAFLD risk factors along with the particular diagnostic methods used. Investigations like liver biopsy and ultrasound abdomen have their limitations. Liver biopsy is invasive on the other hand ultrasound has less sensitivity. Several others are in the list, but are cost ineffective. Among the several non-invasive biomarkers, recently developed Novel Fibrosis Index (NFI) is a new addition. Newly developed NFI was developed by observing the various relationships and variations of serum bilirubin, alkaline phosphatase, platelet count and serum albumin in liver fibrosis.This hospital based observational cross section study was conducted from June 2020 to May 2021in 76 study population of Assam Medical College and Hospital. Type II Diabetes mellitus patients having more than 18 years were included after consent. Alcoholics, pregnant women and patients with secondary cause of hepatic steatosis [Hepatitis B, Hepatitis C, Wilson disease, Autoimmune hepatitis, Hypothyroidism, starvation, Parenteral nutrition, On medications like (valproate, corticosteroids, antivirals)] were excluded. Novel fibrosis Index (NFI) were calculated by [Bilirubin×(ALP)²/Platelet count(Albumin)²] in study population. Fibroscan 402 is used for fibrosis stage assessment. Ziol transient elastography breaking point were used for staging of fibrosis in study population according to Metavir system of fibrosis. Area under the curves of NFI and APRI for different fibrosis stages were obtained by ROC curves using SPSS software edition 21.0.NFI and APRI where able to predict fibrosis stage with correlation coefficient indices 0.5174 and 0.5369 respectively. Area under the ROC curve for NFI and APRI were 0.807 and 0.793 respectively for discriminating F0-F1 and above. Area under the ROC curve for discriminating F0-F2 and above for NFI and APRI were 0.814 and 0.810. Area under the ROC curve for discriminating F0-F3 and above for NFI and APRI were 0.935 and 0.913.Aggregate measures of performance across all possible classification threshold for NFI is better then APRI.