APRI and FIB-4 - a simple predictor of fibrosis in NAFLD/NASH at the primary care level - A case report

The importance of simple investigations like platelets, AST (Aspartate aminotransferase) and ALT (Alanine aminotransferase) when managing patients with NAFLD (non-alcoholic fatty liver disease) and NASH (non-alcoholic steatohepatitis) in primary care should not be overlooked, as this would predict the progression to fibrosis and cirrhosis. A better control of diabetes, metabolic syndrome and the reduction of bodyweight at an early stage when the APRI (AST to Platelet ratio index) and/or FIB-4 score is significant, would have delayed/aborted the progression to fibrosis and cirrhosis is highlighted by this case report. Physicians in primary care should be aware of the significance of low platelet count and high AST (a ‘red flag’) in a case of NAFLD and NASH, and should provide intense control of diabetes, obesity and metabolic syndrome followed by a referral to a gastroenterologist/hepatologist at an early stage. Key words: Primary Care, General Practice, NASH, NAFLD, FIB-4, APRI, Red flag, low platelet, cirrhosis, primary prevention