Evaluation of NAFLD and fibrosis in obese patients - a comparison of histological and clinical scoring systems

S.M.T. Schmitz*, A. Kroh, T.F. Ulmer, J. Andruszkow, T. Luedde, J.F. Brozat, U.P. Neumann, P.H. Alizai

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients.MethodsIn a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score.ResultsAPRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC=0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score.ConclusionsAPRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.
Original languageEnglish
Article number254
Number of pages9
JournalBMC Gastroenterology
Volume20
Issue number1
DOIs
Publication statusPublished - 5 Aug 2020

Keywords

  • apri
  • biopsy
  • epidemiology
  • fatty liver-disease
  • fibrosis
  • hepatitis
  • liver biopsy
  • nafld
  • non-invasive tests
  • nonalcoholic steatohepatitis
  • predict
  • saf score
  • sampling variability
  • scoring system
  • simple noninvasive index
  • steatosis
  • transplantation
  • NAFLD
  • FATTY LIVER-DISEASE
  • BIOPSY
  • NONALCOHOLIC STEATOHEPATITIS
  • TRANSPLANTATION
  • SIMPLE NONINVASIVE INDEX
  • SAF SCORE
  • Liver biopsy
  • SAMPLING VARIABILITY
  • Steatosis
  • Non-invasive tests
  • HEPATITIS
  • PREDICT
  • Scoring system
  • Fibrosis
  • APRI
  • EPIDEMIOLOGY

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