A Model Incorporating Serum Alkaline Phosphatase for Prediction of Liver Fibrosis in Adults with Obesity and Nonalcoholic Fatty Liver Disease.

Ahmad Hassan Ali,Elizabeth J Parks,Andrew A Wheeler,Jamal A Ibdah,Nicole M Spencer,Alhareth Al Juboori,James B Pitt,R Scott Rector,Rama R Ganga,Gregory F Petroski,Alberto A Diaz-Arias,Ghassan M Hammoud

doi:10.3390/jcm10153311

Abstract

We assessed the relationship between serum alkaline phosphatase (ALP) and liver fibrosis by histology, in addition to other noninvasive parameters, in obese patients undergoing metabolic surgery. Patients scheduled for elective bariatric surgery were prospectively recruited from a bariatric clinic. An intraoperative liver biopsy was performed, and liver histology was evaluated by a pathologist blinded to the patients’ data. The endpoint was significant fibrosis defined as fibrosis stage ≥ 2. Independent predictors of fibrosis were identified by logistic regression. Two hundred ten patients were recruited. Liver histology revealed steatosis in 87.1%, steatohepatitis in 21.9%, and significant fibrosis in 10%. Independent predictors of significant fibrosis were ALP (Odds Ratio (OR) 1.03; 95% Confidence interval (CI), 1.01–1.05), alanine aminotransferase (OR 1.02; 95% CI, 1.01–1.03), HbA1c (OR 1.58; 95% CI, 1.20–2.09), and body mass index (OR 1.06; 95% CI, 1.00–1.13). A tree-based model was developed to predict significant fibrosis, with a receiver operating characteristic (ROC) area of 0.845, sensitivity of 0.857, specificity of 0.836, and accuracy of 0.931. The applicability of serum ALP as an independent biomarker of liver fibrosis should be considered in obesity surgery patients, and in the broader context of obese patients with nonalcoholic fatty liver disease.

Highlights

The term nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver diseases characterized by fatty infiltration of the liver
Specifpling, we report for the first time the prognostic relevance of serum alkaline phosphatase (ALP) in these patients
The present analysis identified that serum ALP levels can be useful in predictliver fibrosis stage ≥2 in obese patients with NAFLD

Summary

Introduction

The term nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver diseases characterized by fatty infiltration of the liver. The term nonalcoholic steatohepatitis (NASH) is used. The increased incidence of NAFLD has paralleled a continued rise in the prevalence of morbid obesity. A tremendous interest exists in utilizing noninvasive, readily available, and inexpensive clinical parameters as means of assessing the stage of fibrosis in patients with chronic liver disease. Several models have been developed to serve that purpose [10,11,12] These models have been developed largely from patients diagnosed with NASH to predict advanced fibrosis (F3–F4); their applicability in obese patients undergoing elective metabolic surgery is limited due to the low prevalence of moderate-to-severe stage

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Conclusion