Factors Associated with Severe Non-Alcoholic Steatohepatitis According to the FLIP Algorithm / SAF Score in Adults with Obesity from a Bariatric Center In Peru

Abstract

Background: Obesity is a chronic disease associated with non-alcoholic steatohepatitis (NASH). The more advanced NASH stages tend to be associated with an increased risk of cirrhosis and hepatocellular carcinoma. The FLIP algorithm and the SAF score are useful for diagnosing and stratifying the disease based on its severity. No studies using FLIP and SAF in the Latino population have been reported. Aim: To assess the factors associated with severe NASH according to the FLIP algorithm / SAF score in adults with obesity undergoing bariatric surgery. Methods: We conducted a cross-sectional study using the Clinica Avendaño database. Anthropometric, clinical and laboratory data of patients with obesity (BMI ≥30 m2) were analyzed. The outcome was severe NASH, defined as a grade of activity ''A'' ≥3 and/or a stage of Fibrosis ''F'' ≥3. We developed crude and adjusted regression models with Poisson family, log link function and robust variances for assessing the factors associated with the outcome. Results: The prevalence of severe NASH was 56.5%. In the parsimonious multiple regression model, the age (escalated by 10 years) (PRa: 1.13; 95%CI: 1.02-1.25), metabolic syndrome (PRa: 1.51, 95%CI: 1.17 - 1.96), prothrombin time (PRa: 0.92; 95%CI: 0.86 - 0.99) and alkaline phosphatase (escalated by 10 IU/L) (PRa: 1.02; 95% CI: 1.01-1.04) showed an association with severe NASH. Conclusion: This is the first study in a Latino population that assesses severe NASH using the FLIP / SAF. We found a high prevalence and different important associated factors.