Non-alcoholic steatofibrosis (NASF) can independently predict mortality in patients with non-alcoholic fatty liver disease (NAFLD) (original) (raw)
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Tropical doctor, 2018
Introduction To determine the factors predicting non-alcoholic steatohepatitis (NASH) and advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Methodology All patients aged >18 years and having a fatty liver on abdominal ultrasound (US), presenting from January 2011 to January 2017, were included. A liver biopsy was performed on all the patients. Results Of 96 patients undergoing liver biopsy for non-alcoholic fatty liver disease (NAFLD), 76 (79.2%) were men. On liver US, diffuse fatty liver (DFL) was noted in 68 (70.8%) patients. Liver biopsy showed non-alcoholic steatohepatitis (NASH) in 78 (81.3%) patients. Factors associated with NASH were male gender, body mass index (BMI) > 27 kg/m, DFL and raised alanine aminotransferase (ALT). A GULAB score (based on gender, US liver findings, lipid (fasting) levels, ALT level and BMI) of ≥5 predicted NASH with 82.05% sensitivity. Factors associated with advanced fibrosis in NAFLD were age >40 years, diabete...
Hepatology, 2013
The clinical and public health significance of non-alcoholic fatty liver disease (NAFLD) is not well established. We investigate the long-term impact of NAFLD on mortality. This analysis utilizes the National Health and Nutrition Examination Survey conducted in 1988-1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the AST-platelet ratio index (APRI), and the FIB-4 score. Out of 11,154 participants, 34.0% had NAFLD-the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS < −1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS > 0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age-and sex-adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.93-1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (HR 1.69 (95% CI 1.09-2.63) for NFS, 1.85 (1.02-3.37) for APRI, 1.66 (0.98-2.82) for FIB-4) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (HR 3.46 (95% CI 1.91-6.25) for NFS, 2.53 (1.33-4.83) for APRI, 2.68 (1.44-4.99) for FIB-4).
J Gastrointestin Liver …, 2011
The aim of our study was to assess the clinical and biological parameters associated with Nonalcoholic steatohepatitis (NASH) and to establish the predictors of significant fibrosis in Nonalcoholic fatty liver disease (NAFLD) patients. Methods: We correlated clinical and biochemical parameters with histological features (simple steatosis or steatohepatitis) in 97 patients with NAFLD admitted to the University Hospital Bucharest for persistently raised aminotransferase levels. The biochemical parameters included lipid profile, glucose, liver tests and insulin. The Homeostatic Metabolic Assesment (HOMA)-index and the oxidative stress were also evaluated. Factors associated with NASH and severe fibrosis (F≥3) were identified using the Mann-Whitney U test and multivariate analysis. The overall validity was measured using the area under receiver operating characteristic curve (AUROC) with 95% CI. Results: At univariate analysis, age, BMI, splenic longitudinal diameter (SLD), HOMA, gamma glutamyl transpeptidase, C-reactive protein (CRP), albumin and INR were significantly associated with histologically proven NASH. The multivariate analysis identified four independent predictive factors for the presence of NASH: CRP (p=0.004), SLD (p=0.018), HOMA (p=0.03) and albumin level (p=0.041). The variables independently associated with severe fibrosis were albumin (p=0.008), blood glucose (p=0.017) and BMI (p=0.048). Conclusion: A predictive model that incorporates the clinical and biological parameters may identify at-risk patients with NAFLD, avoiding liver biopsy on a routine basis.
Risk Predictors of Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease
Diagnostics
The assessment of fibrosis in chronic liver diseases using non-invasive methods is an important topic in hepatology. The aim of this study is to identify patients with non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis by establishing correlations between biological/ultrasound markers and non-invasively measured liver stiffness. This study enrolled 116 patients with non-alcoholic fatty liver disease, which were evaluated clinically, biologically, and by ultrasound. Liver fibrosis was quantified by measuring liver stiffness by shear wave elastography (SWE). Multiple correlation analysis of predictors of liver fibrosis identified a number of clinical, biological, and ultrasound parameters (BMI, blood glucose, albumin, platelet count, portal vein diameter, bipolar spleen diameter) that are associated with advanced liver fibrosis in patients with non-alcoholic fatty liver disease. The correlations between the degree of liver fibrosis and the risk values of some serolo...
2016
The nonalcoholic fatty liver disease (NAFLD) represents a group of conditions that range from simple steatosis to nonalcoholic steatohepatitis(NASH). Because steatohepatitis can progress to fibrosis and cirrhosis – liver failure, it is beginning to be recognized as an important cause of liver-related morbidity and mortality. Liver biopsy, which is considered an invasive procedure, is the gold standard for assessing histologic lesion in NAFLD. The aim of our study was to evaluate the biological and clinical parameters correlated with NAFLD and the non invasive markers that can be predictors of fibrosis in these patients. 51 patients admitted to the University Hospital Bucharest during 1 year with NAFLD were included. Histological diagnoses used Kleiner et al’s scoring system. Fibrotest and BARD scores were used. The sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) and the area under the ROC curves (AUROC) were assessed. In 14 patients fibrosis wa...
Metabolism and Target Organ Damage, 2023
Liver fibrosis is critical for liver-related outcomes and mortality in chronic liver disease, irrespective of etiology, including nonalcoholic fatty liver disease (NAFLD). NAFLD has been viewed as an independent correlate of cardiovascular risk. This review article briefly describes the cellular and molecular pathomechanisms underlying hepatic fibrosis. We then address noninvasive assessment of liver fibrosis. Finally, we discuss published evidence supporting fibrosis biomarkers’ role in assessing cardiovascular risk among patients with NAFLD. While histological assessment is the diagnostic standard of hepatic fibrosis, we specifically address noninvasive techniques, including equations based on anthropometric parameters, laboratory indices, and elastometry obtained with imaging techniques. The former group includes AST: ALT ratio, the Forns Index, the AST-to-platelet ratio index score, BARD (BMI, AAR, Diabetes) score, the fibrosis-4 index (FIB-4), the NAFLD fibrosis score, the gamma-glutamyl transferase-to-platelet ratio, and the Hepamet fibrosis score. The latter comprises elastographic techniques associated with ultrasonography or magnetic resonance. Our literature review identified numerous studies demonstrating that biomarkers of fibrosis (the most common being FIB-4) and elastographic techniques predict overall mortality and major cardiovascular events among NAFLD patients. The mechanisms accounting for this association are briefly reviewed. In addition to assessing hepatic fibrosis at baseline, during follow-up, and after therapeutic interventions in NAFLD patients, noninvasive assessment of hepatic fibrosis may predict cardiovascular events and overall mortality in these patients.
Hepatology (Baltimore, Md.), 2017
NAFLD is a spectrum comprised of isolated steatosis, NASH, advanced fibrosis, and cirrhosis. The majority of NAFLD subjects do not have NASH and don't carry a significant risk for adverse outcomes (cirrhosis and mortality). Globally, the prevalence of NAFLD is approximately 25%. In Asia, a gradient of high prevalence rates to low rates are noted from urban to rural areas. Given the prevalence of NAFLD, the clinical and economic burden of NAFLD and NASH can be substantial. With increasing recognition as an important liver disease, the diagnosis of NASH still requires a liver biopsy which is suboptimal. Although liver biopsy is the most accurate modality to diagnose and stage the severity of NASH, it suffers from being invasive, costly, associated with potential complications, and plagued with interobserver variability of individual pathologic features. A number of non-invasive modalities to diagnose NASH and stage liver fibrosis are being developed. These include predictive model...
World journal of gastroenterology, 2015
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world, with a prevalence of 20%. In a subgroup of patients, inflammation, ballooning degeneration of hepatocytes and a varying degree of fibrosis may develop, a condition named non-alcoholic steatohepatitis. Advanced liver fibrosis (stage F3) and cirrhosis (stage F4) are histologic features that most accurately predict increased mortality in both liver-related and cardiovascular diseases. Patients with advanced fibrosis or cirrhosis are at risk for complications such as hepatocellular carcinoma and esophageal varices and should therefore be included in surveillance programs. However, liver disease and fibrosis are often unrecognized in patients with NAFLD, possibly leading to a delayed diagnosis of complications. The early diagnosis of advanced fibrosis in NAFLD is therefore crucial, and it can be accomplished using serum biomarkers (e.g., the NAFLD Fibrosis Score, Fib-4 Index or BARD) or non-i...
Obesity Surgery, 2001
Background: Non-alcoholic steatohepatitis (NASH) is a clinicopathological entity characterized by the presence of steatosis and lobular and/or portal inflammation with or without fibrosis. Patients with non-alcoholic fatty liver and fibrosis on liver biopsy have increased liver-related deaths. Methods: 181 wedge liver biopsies, taken at the time of bariatric surgery from patients with a mean body mass index (BMI) of 47, were studied. In all cases, the liver biopsy was performed without knowledge of the patient's clinical and biochemical data, which were then examined with univariate and multivariate analysis. Results: Diagnosis of NASH was established in 105 patients (91%); 74 patients (70%) showed mild steatosis, 20 (19%) had moderate inflammation and fibrosis, and 11 (10%) had steatosis with severe fibrosis. None of the liver biopsies showed cirrhosis. Age was the only independent predictor of moderate and severe fibrosis (p=0.001). Conclusions: Since only age was a predictor of moderate or severe fibrosis, and no clinical or biochemical abnormalities detected slowly progressive hepatic fibrosis, liver biopsy is the only means of detecting progression to more advanced liver disease in a NASH patient.