Mo1019 Adipose Tissue Insulin Resistance and Lipotoxicity Drive Disease Phenotype and Decline in Pancreatic Beta Cell Function in Nonalcoholic Fatty Liver Disease

Abstract

BACKGROUND: The evaluation of liver fibrosis in patients with non alcoholic fatty liver disease (NAFLD) is important in predicting to predict the outcome of disease. Liver biopsy is the gold standard whereas the noninvasive scoring systems for liver fibrosis assessment in NAFLD patients have been studied and showed promising results. We aimed to validate the utility of these noninvasive scoring systems to identify patients with advanced fibrosis (.F3) in the Thai NAFLD populationMETHODS: This is a cross sectional study to collect 115 liver biopsy-proven NAFLD patients during Jan 2009-Dec 2011 at the King Chulalongkorn Memorial Hospital (KCMH) and Ramathibodi Hospital, Bangkok, Thailand. Four noninvasive scoring systems including AST/ALT ratio, BARD score, FIB-4 and NAFLD Fibrosis Score (NFS) were used to identify patients with advanced fibrosis. RESULTS: One hundred and fifteen liver biopsy proven NAFLD patients were included with mean age of 50.5+/12.4 years and 49.6% of them were male. Eighty patients (69.6%) had impaired fasting glucose or diabetes. 15 patients (13%) showed advanced fibrosis by liver histology. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of these 4 tools were shown in Table 1. BARD score .2 is the best tool with highest sensitivity to screen patients with advanced fibrosis, followed by NFS with cut-off .-1.455, FIB-4 with cut off .1.45 and AST/ALT ratio .0.8, respectively. By using these 4 noninvasive scoring systems, liver biopsy could potentially be avoided in 60% of patients with NFS, 62% with BARD score, 74% with FIB-4, and 84% with AST/ALT ratio (Table 1). CONCLUSIONS: With the prevalence of advanced liver fibrosis of 13% in Thai NAFLD population, these 4 non invasive scoring systems can be used to identify patients with advanced fibrosis with the acceptable sensitivity and high NPV so that liver biopsy could potentially be avoided in about two-thirds of patients. Table 1. Comparison of four non-invasive scoring systems for the diagnosis of advanced fibrosis in 115 Thai patients with NAFLD