Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of a metabolic syndrome. To date, liver biopsy has been the gold standard used to differentiate between simple steatosis and steatohepatitis/fibrosis. Our aim was to compare the relevance of serum non-invasive parameters and scoring systems in the staging of liver fibrosis and non-alcoholic steatohepatitis (NASH) in patients with NAFLD.Methods and FindingsA total of 112 consecutive patients diagnosed with NAFLD were included. A liver biopsy was performed on 56 patients. The Kleiner score was used for the staging and grading of the histology. Non-invasive parameters for fibrosis (hyaluronic acid; AST/ALT; fibrosis scoring indexes OELF, ELF, BARD score, APRI, NAFLD fibrosis score); and inflammation (M30 and M65 cytokeratin-18 fragments) were measured and calculated. The same analyses were performed in 56 patients diagnosed with NAFLD, who were not indicated for liver biopsy. Based on the liver histology, NASH was diagnosed in 38 patients; simple steatosis in 18 patients. A cut-off value of 750 U/L of serum M65 discriminated patients with and without NASH with a 80% sensitivity and 82% specificity (95% CI:57–95). Fibrosis stage F0–F2 was present in 39 patients; F3–F4 in 17 patients. Serum concentrations of hyaluronic acid were higher in patients with advanced fibrosis (p<0.01); a cut-off value of 25 µg/l discriminated patients with F3–F4 with a 90% sensitivity and 84% specificity from those with F0–F2 (95% CI:59–99). When applying the non-invasive criteria to those patients without a liver biopsy, NASH could only be diagnosed in 16%; however, advanced fibrosis could be diagnosed in 35% of them.ConclusionsIn patients with NAFLD, non-invasive serum parameters with a high accuracy can differentiate those patients with NASH and/or advanced fibrosis from those with simple steatosis. A substantial portion of those patients not indicated for liver biopsy might have undiagnosed advanced fibrosis.
Highlights
Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of a metabolic syndrome, a disease affecting a substantial portion of modern populations [1]
In patients with NAFLD, non-invasive serum parameters with a high accuracy can differentiate those patients with nonalcoholic steatohepatitis (NASH) and/or advanced fibrosis from those with simple steatosis
A substantial portion of those patients not indicated for liver biopsy might have undiagnosed advanced fibrosis
Summary
Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of a metabolic syndrome, a disease affecting a substantial portion of modern populations [1]. NAFLD comprises a spectrum of conditions from simple steatosis, through non-alcoholic steatohepatitis (NASH), ending with liver cirrhosis. Whereas simple liver steatosis is regarded as a benign condition, NASH can be a progressive liver disease leading to fibrosis and to cirrhosis. A liver biopsy is an invasive diagnostic method which is distressing to patients. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of a metabolic syndrome. Liver biopsy has been the gold standard used to differentiate between simple steatosis and steatohepatitis/fibrosis. Our aim was to compare the relevance of serum non-invasive parameters and scoring systems in the staging of liver fibrosis and nonalcoholic steatohepatitis (NASH) in patients with NAFLD
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