Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery

Abstract

-Context -Morbidly obese patients have an increased risk for nonalcoholic fat liver disease. Its severe form, nonalcoholic steatohepatitis may cause liver fibrosis. The diagnosis of advanced fibrosis has great value during the pre operative evaluation for bariatric surgery. Currently, liver biopsy is the gold standard for diagnosis of liver fibrosis. Objective -To evaluate the nonalcoholic fat liver disease fibrosis score in morbidly obese patients undergoing Roux-en-Y gastric bypass in our population. Methods -One hundred fifty-eight morbidly obese patients that had undergone bariatric surgery were included. Age, body mass index, hyperglycemia, platelet count, albumin and AST/ALT ratio were applied to the score formula. Scores above 0.676 were indicative of advanced liver fibrosis and scores under -1,455 absence of advanced liver fibrosis. These scores were compared to liver biopsy findings. Results -The presence of advanced fibrosis could be diagnosed with good accuracy, with a positive predictive value of 83.7%. The score had a higher accuracy to exclude advanced fibrosis with a negative predictive value of 97%. Twenty-five patients (16%) had scores between the cutoffs points and were identified as indeterminate. The score sensibility and specificity was 83% and 97% respectively. Conclusions -The nonalcoholic fat liver disease fibrosis score has high accuracy to identify and exclude advanced liver fibrosis in morbidly obese patients subjected to bariatric surgery.

Influence of type 2 diabetes mellitus on liver histology among morbidly obese individuals. A cross-sectional study

“…Of these, the NAFLD fibrosis score is the most widely known nowadays. [24][25][26][27] This study showed that T2DM was significantly associated with the presence of NAFLD in a morbidly obese population.…”

Systematic review and meta‐analysis: non‐invasive detection of non‐alcoholic fatty liver disease related fibrosis in the obese

“…Nine of these recruited patients from obese‐only cohorts. Five bariatric surgical studies reported liver biopsies on all bariatric surgical patients . In all studies, one or two dedicated pathologists scored all liver biopsies.…”

“…Most studies recruited from liver disease setting ('average-obese' study), with only 12 studies recruiting specifically from settings where only obese patients are treated ('obese-only' study). These obese-only settings included bariatric or obesity clinics (7,8,15,29,32,35,40,41,(43)(44)(45)47). Demographics and baseline characteristics of obese-only cohorts were substantially different from average-obese cohorts ( Table 2).…”

“…Twenty-three studies assessed diagnostic accuracy in a population with confirmed histological diagnosis of NAFLD, excluding patients with <5% steatosis. Fifteen studies (7,8,15,(28)(29)(30)32,33,35,41,43,44,46,50,51) included all recruited patients in the final analysis, regardless of histological NAFLD diagnosis. Nine of these recruited patients from obese-only cohorts.…”

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

“…The NFS has two cut-off values used to evaluate liver fibrosis, namely, <-1.455 (low probability) and >+0.676 (high probability). According to a meta-analysis of 13 studies performed in 3,064 patients,24,25,80-91 NFS showed a high area under the receiver operating characteristic curve (AUROC) value of 0.85 in diagnosing liver fibrosis worse than stage F3. Taking <-1.455 as a cut-off, the sensitivity was 90% and the specificity was 60% in excluding advanced liver fibrosis.…”