OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES.

Miller Barreto De Brito E Silva,Marco Aurelio Santo,Francisco Tustumi,Roberto De-Cleva,Sergio Carlos Nahas,Barbara Cristina Jardim Miranda,Denis Pajecki,Anna Carolina Batista Dantas

doi:10.1590/0102-672020210002e1626

Abstract

ABSTRACT - INTRODUCTION:Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients.OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population.METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery.RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m2 (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%.CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.

Highlights

Vsaerriuzems elasobfoárgaictoasry e gásptraicraasm. eters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery
Insulin resistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals

Summary

ARTIGO ORIGINAL

Aobesidade e o sobrepeso estão aumentando sua incidência em todo o mundo, e várias comorbidades relacionadas à obesidade também estão acompanhando seu crescimento[19]. Participantes Este é um estudo transversal, avaliando o desempenho diagnóstico de diferentes escores de doença hepática gordurosa não alcoólica com base em análises bioquímicas para predição de esteatose grave. Escores bioquímicos Com base na análise bioquímica, foram estimados os seguintes escores: AST para Índice de Razão de Plaquetas (APRI); Pontuação de fibrose da doença hepática gordurosa não alcoólica (NALFDS); Fibrose-4 (FIB-4); Razão AST para ALT (AST / ALT); Índice de Esteatose Hepática (HSI); e Avaliação do Modelo Homeostático para Resistência à Insulina (HOMA-IR). OBESIDADE E ESTEATOSE GRAVE: A IMPORTÂNCIA DA AVALIAÇÃO BIOQUÍMICA E ESCORES de cada pontuação para predição de esteatose grave (> 66% das células hepáticas repletas de gordura) foi avaliado pela curva característica de operação do receptor (ROC). Tabela 3 - A área sob a curva das diferentes pontuações

NAS escore

Findings

Modelo ROC z