Emerging new standard for non-invasive assessment of liver disease mortality in non-alcoholic fatty liver disease

Loo, S.; Chan, Wah‐Kheong

doi:10.21037/hbsn.2017.03.06

Cited by 8 publications

(7 citation statements)

References 10 publications

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“…On the other hand, the lower 19‐U/L cut‐off for female had slightly better sensitivity at the expense of specificity. However, previous studies have shown that elevated serum aminotransferase level in patients with NAFLD may still be useful to prompt the clinician to suspect the presence of NASH …”

Section: Discussionmentioning

confidence: 99%

“…However, previous studies have shown that elevated serum aminotransferase level in patients with NAFLD may still be useful to prompt the clinician to suspect the presence of NASH. 25,26 The latest Asia Pacific Working Party on NAFLD Guideline also recommends that patients diagnosed with NAFLD by screening should receive advice and support for lifestyle intervention and be assessed for other components of metabolic syndrome and be treated accordingly. 1 Lifestyle intervention with ≥ 10% weight loss has been shown to resolve NASH and can even lead to fibrosis improvement.…”

Section: Discussionmentioning

confidence: 99%

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Screening for non‐alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography

Lai

Yusoff

Vethakkan

et al. 2019

J of Gastro and Hepatol

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Background and Aim The recommendation in regard to screening for non‐alcoholic fatty liver disease (NAFLD) among type 2 diabetes mellitus (T2DM) patients differs in major guidelines. The aim of this paper was to study the prevalence of NALFD and advanced fibrosis among T2DM patients. Methods This is a cross‐sectional study of consecutive adult T2DM patients attending the Diabetes Clinic of a university hospital. Significant hepatic steatosis and advanced fibrosis was diagnosed based on transient elastography if the controlled attenuation parameter was ≥ 263 dB/m, and the liver stiffness measurement was ≥ 9.6 kPa using the M probe or ≥ 9.3 kPa using the XL probe, respectively. Patients with liver stiffness measurement ≥ 8 kPa were referred to the Gastroenterology and Hepatology Clinic for further assessment, including liver biopsy. Results The data of 557 patients were analyzed (mean age 61.4 ± 10.8 years, male 40.6%). The prevalence of NAFLD and advanced fibrosis based on transient elastography was 72.4% and 21.0%, respectively. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR 4.856, 95% confidence interval [CI] 2.749–8.577, P = 0.006), serum triglyceride (OR 1.585, 95% CI 1.056–2.381, P = 0.026), and alanine aminotransferase levels (OR 1.047, 95% CI 1.025–1.070, P < 0.001) while advanced fibrosis was associated with serum high‐density lipoprotein cholesterol (OR 0.355, 95% CI 0.126–0.997, P = 0.049), alanine aminotransferase (OR 1.023, 95% CI 1.009–1.037, P = 0.001), γ‐glutamyltransferase (OR 1.005, 95% CI 1.001–1.008, P = 0.017), and platelet levels (OR 0.995, 95% CI 0.992–0.999, P = 0.010). Seventy‐one patients underwent liver biopsy. The majority had non‐alcoholic steatohepatitis (83.1%) and ≥ F1 fibrosis (87.3%) while advanced fibrosis was seen in 36.6%. Conclusion The prevalence of NAFLD and advanced fibrosis based on transient elastography is high among T2DM patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Screening for non‐alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography

Lai

Yusoff

Vethakkan

et al. 2019

J of Gastro and Hepatol

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“…However, normal serum AST level has very poor negative predictive value for NASH. 39 The acNASH index combines serum AST and creatinine levels for the diagnosis of NASH and was found to have good diagnostic performance with an AUROC of 0.82 and 0.81 in the derivation cohort and validation cohort, respectively. 40 While NASH drives the progression of liver disease, it is evident that the key prognostic feature in NAFLD is the stage of fibrosis.…”

Section: Non-invasive Assessment For Nashmentioning

confidence: 96%

Non-invasive assessment of metabolic dysfunction–associated fatty liver disease

Kumar

Skantha

Chan

2022

Therapeutic Advances in Endocrinology

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Non-alcoholic fatty liver disease (NAFLD) affects an estimated one-quarter of the global adult population and has become one of the leading causes of end-stage liver disease and hepatocellular carcinoma with increased liver-related and overall morbidity and mortality. The new term, metabolic dysfunction–associated fatty liver disease (MAFLD), has a set of positive diagnostic criteria and has been shown to have better clinical utility, but it has yet to be universally adopted. This review addresses the non-invasive tests for MAFLD and is based mostly on studies on NAFLD patients, as the MAFLD term is relatively new and there are limited studies on non-invasive tests based on this new term, while a large body of research work on non-invasive tests has accumulated in the literature for NAFLD. This review focuses on blood-based biomarkers and scores for the assessment of hepatic steatosis, non-alcoholic steatohepatitis (NASH), and fibrosis, and two of the most widely studied imaging biomarkers, namely vibration-controlled transient elastography and magnetic resonance imaging. Fibrotic NASH has become a diagnostic target of interest and novel serum biomarkers and scores incorporating imaging biomarker for diagnosis of fibrotic NASH are emerging. Nonetheless, the degree of liver fibrosis remains the key predictor of liver-related morbidity and mortality in patients with MAFLD. A multitude of non-invasive biomarkers and scores have been studied for the detection of liver fibrosis, including use of sequential non-invasive tests for risk stratification of advanced liver fibrosis. In addition, this review will explore the utility of the non-invasive tests for prognostication and for monitoring of treatment response.

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“…A simple and reliable noninvasive test for the diagnosis and follow‐up of NASH is much needed in the management of NAFLD patients. While elevated serum aminotransferase level, for example, aspartate aminotransferase level, has been shown to have good positive predictive value for the diagnosis of NASH, it is well recognized that serum aminotransferase level may be normal even in the presence of advanced liver disease in NAFLD patients . Our group has previously evaluated other biomarkers, namely, the cytokeratin‐18 fragment CK18Asp396 or M30 and the Wisteria floribunda agglutinin‐positive Mac‐2 binding protein, for the assessment of the severity of NAFLD using samples collected from our large cohort of biopsy‐proven NAFLD patients.…”

Section: Introductionmentioning

confidence: 99%

Limited applicability of cathepsin D for the diagnosis and monitoring of non‐alcoholic steatohepatitis

et al. 2019

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Background and Aim To date, there are limited data on the applicability of cathepsin D for the diagnosis and monitoring of non‐alcoholic steatohepatitis (NASH). Methods This study included patients with biopsy‐proven non‐alcoholic fatty liver disease (NAFLD) diagnosed between November 2012 and October 2015. Serum cathepsin D levels were measured using the CatD enzyme‐linked immunosorbent assay (USCN Life Science, Wuhan, China) using stored samples collected on the same day of the liver biopsy procedure. The performance of cathepsin D in the diagnosis and monitoring of NASH was evaluated using receiver operating characteristic analysis. Results Data for 216 liver biopsies and 34 healthy controls were analyzed. The mean cathepsin D level was not significantly different between NAFLD patients and controls; between NASH and non‐NASH patients; and across the different steatosis, lobular inflammation, and hepatocyte ballooning grades. The area under receiver operating characteristic curve (AUROC) of cathepsin D for the diagnosis of NAFLD and NASH was 0.62 and 0.52, respectively. The AUROC of cathepsin D for the diagnosis of the different steatosis, lobular inflammation, and hepatocyte ballooning grades ranged from 0.51 to 0.58. Of the 216 liver biopsies, 152 were paired liver biopsies from 76 patients who had a repeat liver biopsy after 48 weeks. There was no significant change in the cathepsin D level at follow‐up compared to baseline in patients who had histological improvement or worsening for steatosis, lobular inflammation, and hepatocyte ballooning grades. Cathepsin D was poor for predicting improvement or worsening of steatosis and hepatocyte ballooning, with AUROC ranging from 0.47 to 0.54. It was fair for predicting worsening (AUROC 0.73) but poor for predicting improvement (AUROC 0.54) of lobular inflammation. Conclusion Cathepsin D was a poor biomarker for the diagnosis and monitoring of NASH in our cohort of Asian patients, somewhat inconsistent with previous observations in Caucasian patients. Further studies in different cohorts are needed to verify our observation.

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Emerging new standard for non-invasive assessment of liver disease mortality in non-alcoholic fatty liver disease

Cited by 8 publications

References 10 publications

Screening for non‐alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography

Screening for non‐alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography

Non-invasive assessment of metabolic dysfunction–associated fatty liver disease

Limited applicability of cathepsin D for the diagnosis and monitoring of non‐alcoholic steatohepatitis

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