Hepatorenal index for grading liver steatosis with concomitant fibrosis

Abstract

Introduction Ultrasonography is widely used as the first tool to evaluate fatty liver disease, and the hepatorenal index is a semi-quantitative method that improves its performance. Fibrosis can co-exist with steatosis or even replace it during disease progression. This study aimed to evaluate the influence of fibrosis on the measurement of steatosis using the hepatorenal index. Materials and methods This cross-sectional study included 89 patients with nonalcoholic fatty liver disease and in whom liver fibrosis was determined by ultrasound elastography. The Pearson’s correlation coefficient was used to compare between the results of the sonographic hepatorenal index and the quantification of steatosis using magnetic resonance spectroscopy as well the accuracy of detecting moderate to severe steatosis using sonography in two groups of patients: (A) without advanced fibrosis and (B) with advanced fibrosis. Advanced fibrosis was defined as a shear wave speed ≥ 1.78 m/s on ultrasound elastography. We calculated the area under the curve (AUC-ROC) to detect the ability of the hepatorenal index to differentiate light from moderate to severe steatosis in both groups. Moderate to severe steatosis was defined as a fat fraction > 15% on the magnetic resonance spectroscopy. The intra-observer variability was assessed using the Bland-Altman plot. Results Among patients, the mean age was 54.6 years and 59.6% were women, 50.6% had a body mass index ≥ 30 kg/m2, 29.2% had moderate to severe steatosis, and 27.2% had advanced fibrosis. There was a correlation between steatosis grading by ultrasonography and magnetic resonance in group A (0.73; P < 0.001), but not in Group B (0.33; P = 0.058). The AUC-ROC for detecting a steatosis fraction ≥ 15% was 0.90 and 0.74 in group A and group B, respectively. The intra-observer variability for the hepatorenal index measurements was not significant (-0.036; P = 0.242). Conclusion The hepatorenal index is not appropriate for estimating steatosis in livers with advanced fibrosis.

Revisiting the Hepatorenal Index in the Quantification of Hepatic Steatosis: How it is done and the utility

“…Several authors conducted retrospective studies, which may lead to selection bias, among other limitations that come with this selected method 8,9,11 . In addition, a small number of patients in the study was another standard limitation among authors, 4,7,8 whereas the use of a sole manufacturer's proprietary ultrasound machine could vary the results, according to Johnson et al 4 and Tran et al 11 …”

“…Several authors conducted retrospective studies, which may lead to selection bias, among other limitations that come with this selected method. 8,9,11 In addition, a small number of patients in the study was another standard limitation among authors, 4,7,8 whereas the use of a sole manufacturer's proprietary ultrasound machine could vary the results, according to Johnson et al 4 and Tran et al 11 HRI has several other limitations when it comes to image quality. The operator (sonographer or radiologist) must obtain a diagnostic image paying particular attention to the overall gain setting and the operating frequency used.…”

Non-Invasive Diagnostic of NAFLD in Type 2 Diabetes Mellitus and Risk Stratification: Strengths and Limitations

“…The presence of concomitant fibrosis limits the diagnostic performance of HRI. Stahlschmidt et al reported a limited ability of HRI to differentiate mild from moderate-severe steatosis (fat fraction > 15% on MRS) in patients diagnosed with advanced fibrosis at US elastography (shear wave speed ≥ 1.78 m/s) [90].…”

Non-alcoholic Fatty Liver Disease and Its Association With Left Ventricular Diastolic Dysfunction: A Systematic Review

“…Sheba et al carried out a cross-sectional study in which 40 type 2 DM participants were separated into two groups of 20 each, depending on the presence or absence of NAFLD [ 27 ]. Based on the hepato-renal index (HRI), individuals with NAFLD were classified as having mild, moderate, or severe steatosis [ 41 ]. In comparison to patients with type 2 DM alone, those with type 2 DM and NAFLD had higher peak A, higher left atrial volume, higher peak E/A, lower peak e', and higher left ventricle filling pressure index (E/e').…”