Predictors of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease, Chronic Heptitis B, Chronic Hepatitis C

Abstract

Background and Aim: Transient elastography (TE) using ultrasound offers great promise in providing accurate and reliable information among Non alcoholic fatty liver disease (NAFLD), chronic Hepatitis B (CHB), chronic Hepatitis C (CHC), patients with advanced fibrosis and cirrhosis. The study was done to find out the prevalence and factors associated with advanced fibrosis among NAFLD, CHB, CHC, patients using TE. Methods: All consecutive patients with newly diagnosed NAFLD, CHB, CHC were subjected to anthropometric measurements i.e. Mid-arm circumference (MAC), Triceps skinfold thickness (TST), Waist circumference (WC) and Body Mass Index (BMI). All patients underwent TE and routine investigations like hemogram, liver function test, lipid profile and abdominal ultrasonography. Advanced fibrosis (≥F3/F4) was defined as TE value >11, >9, >9.6 kPa for NAFLD, CHB, CHC respectively. Results: This cross sectional study included 52 patients with NAFLD, 98 with CHB, 71 with CHC. Advanced fibrosis was seen in 50%, 20%, 66.2% patients with NAFLD, CHB, CHC respectively. On univariate analysis, factors significanlty associated with advanced fibrosis among NAFLD patients were older age [P = 0.008], higher BMI [P = 0.029], high SGOT [P = 0.003], USG finding of fatty liver [P = 0.004] and coarse liver [P = 0.002], among CHB patients were older age [P = 0.048], low platelet count [P = 0.002], low serum protein [P = 0.025], USG finding of normal liver [P = 0.004] and coarse liver [P = 0.023], among CHC patients were older age [P = 0.023], increased Bilirubin [P = 0.022], increased SGOT [P = 0.001], low platelet count [P = 0.000], USG findings of normal liver [P = 0.006], fatty liver [P = 0.008] and coarse liver [P = 0.000]. On mulitivariate analysis, factors significantly associated with NAFLD were SGOT [P = 0.016] and coarse ultrasound [P = 0.017], with HBV were normal [P = 0.025] and coarse ultrasound [P = 0.000], low platelet count [P = 0.002], low protein [P = 0.009], with HCV was coarse ultrasound [P = 0.003]. Conclusion: Advanced fibrosis is more common in CHC followed by NAFLD and CHB. Factors predicting advanced fibrosis among NAFLD were SGOT and coarse ultrasound, among CHB were normal and coarse ultrasound, low platelet count, low protein, among CHC was coarse ultrasound. The authors have none to declare.