Liver fibrosis in overweight patients

Abstract

Background & Aims: A common clinical issue is whether overweight patients with abnormal liver function test results should undergo liver biopsy. Although serious liver injury can occur, its prevalence and risk factors are not well known. Methods: Ninety-three consecutive patients with abnormal liver function tests (but without overt liver disease), body mass index (BMI) > 25 kg/m 2, and no alcoholic, viral, autoimmune, drug-induced, or genetic liver disease were retrospectively studied. Clinical, biological, and histological variables were tested for association with septal fibrosis or cirrhosis. Results: Septal fibrosis was present in 28 patients (30%) including cirrhosis in 10 (11%). Age ≥ 50 years (odds ratio [OR], 14.1), BMI ≥ 28 kg/m 2 (OR, 5.7), triglycerides ≥ 1.7 mmol/L (OR, 5), and alanine aminotransferase (ALT) ≥ 2N (OR, 4.6) were independently associated with septal fibrosis. Among histological features, septal fibrosis was strongly associated with necroinflammatory activity (OR, 44). A score combining age, BMI, triglycerides, and ALT had 100% negative predictive value for septal fibrosis when scoring 0 or 1 (100% sensitivity for a specificity of 47%). Conclusions: Septal fibrosis occurs frequently in overweight patients with abnormal liver function tests. A clinicobiological score combining BMI, age, ALT, and triglycerides could improve selection of patients for liver biopsy. GASTROENTEROLOGY 2000;118:1117-1123