Abstract
IntroductionVarious conditions of liver disease and the downsides of liver biopsy call for a non-invasive option to assess liver fibrosis. A non-invasive score would be especially useful to identify patients with slow advancing fibrotic processes, as in Non-Alcoholic Fatty Liver Disease (NAFLD), which should undergo histological examination for fibrosis.Patients/MethodsClassic liver serum parameters, hyaluronic acid (HA) and cell death markers of 126 patients undergoing bariatric surgery for morbid obesity were analyzed by machine learning techniques (logistic regression, k-nearest neighbors, linear support vector machines, rule-based systems, decision trees and random forest (RF)). Specificity, sensitivity and accuracy of the evaluated datasets to predict fibrosis were assessed.ResultsNone of the single parameters (ALT, AST, M30, M60, HA) did differ significantly between patients with a fibrosis score 1 or 2. However, combining these parameters using RFs reached 79% accuracy in fibrosis prediction with a sensitivity of more than 60% and specificity of 77%. Moreover, RFs identified the cell death markers M30 and M65 as more important for the decision than the classic liver parameters.ConclusionOn the basis of serum parameters the generation of a fibrosis scoring system seems feasible, even when only marginally fibrotic tissue is available. Prospective evaluation of novel markers, i.e. cell death parameters, should be performed to identify an optimal set of fibrosis predictors.
Highlights
Various conditions of liver disease and the downsides of liver biopsy call for a non-invasive option to assess liver fibrosis
Patient Characteristics Detailed data of the included patients can be found in table 1, comprising distribution of demographic parameters as well as standard parameters of liver damage
Serum parameters for liver damage were within normal range and no pathological alterations were detected
Summary
Various conditions of liver disease and the downsides of liver biopsy call for a non-invasive option to assess liver fibrosis. A non-invasive score would be especially useful to identify patients with slow advancing fibrotic processes, as in Non-Alcoholic Fatty Liver Disease (NAFLD), which should undergo histological examination for fibrosis. NAFLD may progress to non-alcoholic steatohepatitis (NASH) with or without fibrosis and predisposes to liver cirrhosis, end stage liver disease and hepatocellular carcinoma (HCC) [2]. Liver biopsy is associated with a limited, but significant risk of adverse events (bleeding, infection) and a significant rate of observer- and sampling errors, for assessment of fibrosis [5,6]. Given the high prevalence of NAFLD and the limitations of liver biopsies, biomarkers and surrogate parameters of fibrosis might evolve as important diagnostic means in NAFLD patients
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