Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients.MethodsIn a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score.ResultsAPRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC = 0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score.ConclusionsAPRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis
Liver biopsy has remained to be the gold standard for diagnosing NAFLD and NASH, but such invasive procedures are neither affordable nor indicated in the majority of patients at risk for developing NAFLD [10]
The AASLD practice guidelines suggest the use of non-invasive tools to aid clinical decision, e.g. NAFLD fibrosis score (NFS), FIB-4, aspartate aminotransferase to platelet ratio index (APRI) [17]
Summary
Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. The AASLD practice guidelines suggest the use of non-invasive tools to aid clinical decision, e.g. NAFLD fibrosis score (NFS), FIB-4, aspartate aminotransferase to platelet ratio index (APRI) [17]. Out of these scores, only the NFS has been developed for usage in patients with NAFLD [14].Fib-4 was originally designed for prediction of fibrosis in patients with HIV/HCV coinfection, while APRI was introduced for patients with chronic hepatitis C [11, 16, 18]. The aim of this study was to compare the accuracy of various non-invasive tests to predict NAFLD and fibrosis in obese patients undergoing bariatric surgery
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