Comparison of Non-Invasive Fibrosis Scores Between Alcoholic Liver Disease Patients and Healthy Non-Alcoholics in South Indian Population

Abstract

BACKGROUND Alcoholic Liver Disease (ALD) is a spectrum of disorders ranging from simple steatosis to steatohepatitis and cirrhosis. Various non-invasive markers have been validated as reliable prognostic markers of fibrosis in Chronic Viral Hepatitis and Non-Alcoholic Fatty Liver Disease but their utility in ALD is least evaluated. This study aims to compare the fibrosis scores in ALD patients with non-alcoholic healthy controls. METHODS The non-invasive scores of fibrosis namely AST/ALT ratio, BARD score, APRI and FIB-4 were calculated in 30 ALD cases and 30 age matched controls. Alcohol drinking pattern was evaluated using the AUDIT questionnaire. The difference in the fibrosis scores between cases and controls were calculated using independent student's t test. All statistical analysis were done using SPSS software v 20.0 and p value <0.05 was considered statistically significant. RESULTS All the non-invasive scores of fibrosis viz. AST/ALT ratio, BARD score, APRI and FIB-4 were significantly high in ALD cases compared to controls. All the cases had AST/ALT ratio more than >1, 76% of them had BARD score >2, 97% had APRI score >1 and 73% had FIB-4 score >3.25 denoting the presence of significant fibrosis in ALD patients. AUDIT score correlates with all the non-invasive fibrosis scores except AST/ALT ratio. There is significant correlation between FIB-4 score and APRI score (r= 0.962, p=<0.001) and between FIB-4 score and AST/ALT ratio (r= 0.500 p= 0.005). CONCLUSIONS The non-invasive fibrosis markers are significantly high in ALD cases. APRI, FIB4 and BARD score positively correlate with alcohol drinking pattern. Hence these scores derived from routine lab investigations could be used as cost effective tools to assess the severity of fibrosis in ALD patients.