Disease Progression-Related Markers for Aged Non-Alcoholic Fatty Liver Disease Patients

Abstract

Background and Purpose The progression of fibrosis is recently acknowledged as an important phenomenon in the progression of non-alcoholic fatty liver disease (NAFLD). Standard markers reflecting liver fibrosis (e.g., FIB-4 index or NFS) have been shown to increase with age. This study aimed to identify fibrosis progression-related markers that are beneficial even in aged individuals. Methods A study population of 98 patients diagnosed with NAFLD (non-alcoholic fatty liver [NAFL], n=25; non-alcoholic steatohepatitis [NASH], n=73). Their fibrosis stages were as follows: stage 1 (n=25), stage 2 (n=35), stage 3 (n=33), stage 4 (n=10). Serum levels of pro-inflammatory and anti-inflammatory cytokines were measured by a multiple enzyme-linked immunosorbent assay. Cytokines, the FIB-4 index, and APRI were analyzed to define the best approach to discriminate advanced NAFLD, even in aged (>65 years old) patients. Results The following markers showed significant differences between NAFL and NASH: FIB-4, APRI, IP-10, VEGF, and IL-15. The following markers showed significant differences between stage 1-2 and stage 3-4: FIB-4, APRI, IP-10, VEGF, IL-17, PDGF-BB, and RANTES. The fibrosis stage, FIB-4, APRI, PDGF-BB and RANTES were related to the prognosis. In aged patients, IP-10, GM-CSF, RANTES differed between stage 1-2 and stage 3-4. Conclusion FIB-4 or APRI, standard NAFLD or fibrosis progression-related markers were beneficial not only for their correlation with fibrosis but also for predicting the prognosis. However, in aged patients, the correlation diminished and RANTES (a chemokine) showed all correlations and should be regarded as beneficial marker in NAFLD.