Histological Evaluation of Non-alcoholic Fatty Liver Disease and Its Correlation with Different Noninvasive Scoring Systems with Special Reference to Fibrosis: A Single Center Experience

Abstract

Background: Although liver biopsy remains the gold standard for the diagnosis of non-alcoholic fatty liver disease [NAFLD], many non-invasive markers of liver fibrosis have recently been proposed and assessed as surrogates of liver biopsy. Aims and objective: To evaluate the degree of liver fibrosis by different non-invasive fibrosis scoring systems and to compare each non-invasive fibrosis scoring system with histological fibrosis stage. Materials and methods: The study population consists of consecutive patients with biopsy proven NAFLD. Complete medical history was taken and physical examination was done in all patients along with appropriate biochemical evaluations. NAFLD fibrosis score, BARD score, BAAT score and APRI score were calculated and each score was compared with histological fibrosis staging. Results: The study population consisted of 60 patients having mean age 39.73 years (SD 9.62, range 17-63 years) including 51 (85%) males and 9 (15%) females. On histology fibrosis was present in 68.3% (41/60) patients. Out of 60 patients 41 had fibrosis and among them 17, 22, 2 patients had grade 1, 2, 3 fibrosis respectively and no one had grade 4 fibrosis. 61.67% (37/60) had definite NASH. Comparing the fibrosis of histology with the noninvasive scoring systems, the sensitivity and specificity of NAFLD fibrosis score were 5.56% and 100% respectively. BARD score had 45.83% sensitivity and 80.55% specificity. The sensitivities of BAAT score and APRI score were 0% and 29.16% respectively and the specificities were 100% and 97.22% respectively. Conclusion: The noninvasive scoring systems like NFS, BARD, BAAT, and APRI are not sensitive enough to detect fibrosis but highly specific to include fibrosis if scores are more than cutoff values in our cohort, however they cannot replace liver biopsy. Newer more efficient non-invasive scoring systems have to be devised for the Indian NAFLD population. ( J CLIN EXP HEPATOL 2016;6:291-296)

Hepatoprotective effects of Cassia semen ethanol extract on non-alcoholic fatty liver disease in experimental rat

“…In addition, histopathological changes in liver from microscopy observation correlated with the examination of liver function (Rath et al. 2016; Koo et al. 2017).…”

“…2018), it often developed a histological spectrum starting from simple steatosis to NASH with the characterization of hepatocellular damage, fibrogenesis and lobular necro-inflammation (Rath et al. 2016; Jin et al. 2018), which may evolve to hepatic cirrhosis and HCC (Liu et al.…”

Ultrasonographic Evaluation of Fatty Pancreas in Serbian Patients with Non Alcoholic Fatty Liver Disease—A Cross Sectional Study

“…Non-alcoholic fatty liver disease (NAFLD) presents a spectrum of disorders ranging from simple steatosis and steatohepatitis to fibrosis and cirrhosis [24]. Liver biopsy is a gold standard for diagnosis of liver cirrhosis, however due to its invasive nature noninvasive scoring systems were developed for assessment of fibrosis in patients with NAFLD [25,26]. Rath MM et al concluded that noninvasive scoring systems like NFS, BARD and APRI are not sensitive enough to detect fibrosis, but highly specific to include it for scores higher then specific cut offs [25].…”

“…Liver biopsy is a gold standard for diagnosis of liver cirrhosis, however due to its invasive nature noninvasive scoring systems were developed for assessment of fibrosis in patients with NAFLD [25,26]. Rath MM et al concluded that noninvasive scoring systems like NFS, BARD and APRI are not sensitive enough to detect fibrosis, but highly specific to include it for scores higher then specific cut offs [25]. Van Greenen EJ et al conducted a postmortem study on 80 cadavers and found that total pancreatic fat is a significant predictor for presence of NAFLD, but there was no correlation between pancreatic fat and NAFLD activity score [27].…”

A circulating microRNA signature as noninvasive diagnostic and prognostic biomarkers for nonalcoholic steatohepatitis

“…Liver transaminases (ALT and AST) have been widely used in clinical settings to predict the presence of liver diseases including NASH [ 25 ]. Elevations in circulating ALT level are indicative of hepatocyte damage, and ALT is an important component of several composite NASH scoring systems [ 26 , 27 ]. As ALT and microRNAs are independent measurements of liver functions, we then sought to incorporate ALT into the microRNA signature to see if the performance could be further improved.…”