Abstract
Background and AimThere is no standardized guideline to screen, image, or refer patients with non‐alcoholic fatty liver disease (NAFLD) to a specialist. In this study, we used transient elastography (TE) to examine the fibrosis stages at which patients are first diagnosed with NAFLD. Subsequently, we analyzed metabolic markers to establish cut‐offs beyond which noninvasive imaging should be considered to confirm NAFLD/non‐alcoholic steatohepatitis fibrosis in patients.MethodsCharts spanning July 2015–April 2018 for 116 NAFLD patients who had TE performed were reviewed. Univariate and multivariate analysis of metabolic markers was conducted.ResultsAt the first hepatology visit, TE showed 73% F0–F2 and 27% F3–F4. Univariate analysis showed that high‐density lipoproteins (HDL), hemoglobin A1c (A1c), aspartate transaminase (AST), and alanine transaminase (ALT) were significantly different between the F0–F2 and F3–F4 groups. Multivariate analysis showed that AST (P = 0.01) and A1c (P = 0.05) were significantly different. Optimal cut‐offs for these markers to detect liver fibrosis on TE were AST >43 U/L and A1c >6.6%. The logistic regression function combining these two variables to reflect the probability (P) of the patient having advanced fibrosis (F3–F4) on TE yielded the formula: P = e R/(1 + e R), where R = −8.56 + 0.052 * AST + 0.89 * A1c.ConclusionsOur study suggested that >25% of patients presenting to a specialist for NAFLD may have advanced fibrosis (F3–F4). Diabetes (A1c >6.6%) and AST >43 U/L were the most predictive in identifying NAFLD patients with advanced fibrosis on imaging. We proposed a formula that may be used to prioritize NAFLD patients at higher risk of having advanced fibrosis for specialist referral and imaging follow‐up.
Highlights
Non-alcoholic fatty liver disease (NAFLD) and its more severe inflammatory form, non-alcoholic steatohepatitis (NASH), are two of the most common etiologies of liver disease in the United States today
Cross-sectional imaging, such as ultrasound (US) and magnetic resonance (MR) elastography, has emerged as a safe and reproducible noninvasive way to evaluate the severity of non-alcoholic fatty liver disease (NAFLD)/ NASH by using low-frequency vibrations to measure stiffness of the organ in units of kilopascals and translating these units into different degrees of fibrosis.[2]
A meta-analyses of 50 studies assessed the performance of US elastography (USE) for diagnosis of liver fibrosis and found an increased predictive value of kPa with increase in fibrosis severity grouped as F0–F2 and F3–F4 across different etiologies of chronic liver disease.[6]
Summary
Non-alcoholic fatty liver disease (NAFLD) and its more severe inflammatory form, non-alcoholic steatohepatitis (NASH), are two of the most common etiologies of liver disease in the United States today. There is no standardized guideline to screen, image, or refer patients with non-alcoholic fatty liver disease (NAFLD) to a specialist. We analyzed metabolic markers to establish cut-offs beyond which noninvasive imaging should be considered to confirm NAFLD/non-alcoholic steatohepatitis fibrosis in patients. Univariate analysis showed that high-density lipoproteins (HDL), hemoglobin A1c (A1c), aspartate transaminase (AST), and alanine transaminase (ALT) were significantly different between the F0–F2 and F3–F4 groups. Conclusions: Our study suggested that >25% of patients presenting to a specialist for NAFLD may have advanced fibrosis (F3–F4). Diabetes (A1c >6.6%) and AST >43 U/L were the most predictive in identifying NAFLD patients with advanced fibrosis on imaging. We proposed a formula that may be used to prioritize NAFLD patients at higher risk of having advanced fibrosis for specialist referral and imaging follow-up
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More From: JGH open : an open access journal of gastroenterology and hepatology
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