S1025 The Effects of Age on the Accuracy of the FAST Score to Predict the Presence of NASH With Significant Fibrosis

INTRODUCTION: Typically characterized by more advanced disease in the elderly, clinically significant nonalcoholic steatohepatitis (NASH) can be difficult to identify via noninvasive measures. The FAST (Fibroscan + AST) score was recently developed to predict the presence of NASH with significant fibrosis (NASH-F) based on measuring controlled attenuation parameter (CAP) for steatosis, liver stiffness measurement (LSM) for fibrosis, and AST for inflammation. This study aims to evaluate the effects of age on FAST score to predict clinically significant NASH. METHODS: Consecutive patients who presented for evaluation of fatty liver were included. All had Fibroscan to measure CAP and LSM + AST within 6 months. Based on published data, FAST ≥0.67 was used to rule in the presence of NASH-F, FAST < 0.35 was used to rule out NASH-F and FAST between 0.35 and 0.67 was considered indeterminate. Nominal and continuous variables were analyzed with chi-squared and 2-sided T-tests, respectively. One-way analysis of variance (ANOVA) was used to analyze continuous variables across three age categories: young adults (18–39 years), middle-age (40–64), and elderly (65+). RESULTS: A total of 665 patients were identified of which 338 (67.6%) were female, 265 (66.9%) were Hispanic, 198(29.8%) had diabetes, 382 (58.2%) had hypertension, 505 (75.9%) had hyperlipidemia, and 311 (46.8%) had metabolic syndrome (MetS). A total of 85 (17%) young adults, 306 (66.2%) middle age, and 109 (21.8%) elderly patients were identified. 11 (12.9%) of young adults, 29 (9.5%) of middle age, and 9 (8.3%) elderly had elevated FAST score. When compared across all three age groups, CAP, LSM, AST, ALT, and Fib4 score were all significantly different (P < 0.05 for all). However, neither CAP nor LSM were significantly different between specific age groups on individual comparisons (P > 0.05). ALT showed significant reduction as age progressed (76.2 vs 49.5 vs 39.4, P < 0.001). Similarly, AST was significantly reduced with progressive age (43.6 vs 36.1 vs 33.9, P < 0.001. FAST score was not significantly different as age progressed (P = 0.51). CONCLUSION: With advanced age, we found a significant progressive reduction in AST and ALT. However, neither the results of Fibroscan nor FAST score were significantly different with progressive age. Given that advanced age is generally associated with increased prevalence of NASH-F, this study suggests that FAST score may not be a reliable noninvasive measure of clinically significant NASH in the elderly.