New clinical score to diagnose nonalcoholic steatohepatitis in obese patients

Abstract

BackgroundNonalcoholic fatty liver disease (NAFLD) is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH), cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify individual with NASH in severely obese patients submitted to bariatric surgery.MethodsThe medical records from 66 patients submitted to gastroplasty were reviewed. Their chemistry profile, abdominal ultrasound (US) and liver biopsy done during the surgical procedure were analyzed. Patients were classified into 2 groups according to liver biopsy: Non-NASH group - those patients without NAFLD or with grade I, II or III steatosis; and NASH group - those with steatohepatitis or fibrosis. The t-test was used to compare each variable with normal distribution between NASH and Non-NASH groups. When comparing proportions of categorical variables, we used chi-square or z-test, where appropriate. A p-value < 0.05 was considered statistically significant.Results83% of patients with obesity grades II or III showed NAFLD, and the majority was asymptomatic. Total Cholesterol (TC)≥200 mg/dL, alanine aminotransferase (ALT) ≥30, AST/ALT ratio (AAR)≤ 1, gammaglutaril-transferase (γGT)≥30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, γGT and US) and the simplified score, where US was not included. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH (sensitivity 70%, specificity 88.6%, NPV 91.2%, PPV 63. 6%).ConclusionAlterations in TC, ALT, AAR, γGT and US are related to the most risk for NASH. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH. Additionally, negative final scores exclude the presence of an advanced illness. Using this score, the severity of fatty liver infiltration would be predicted without the risks associated with hepatic biopsy.

Fetuin-A as a Possible Marker of Nonalcoholic Fatty Liver Disease in Patients with Non-Surgical Weight Loss

“…These results suggest a reduction in liver fat content in our patients as well. Furthermore, longitudinal studies show a reduction in FLI and NASH-Scores at the end of the study period suggesting a decrease of NAFLD and NASH in various participants due to the achieved weight loss [23,24]. However, our results show that fetuin-A is not altered after 52 weeks although weight and single values as well as scores of NAFLD suggest that the disease has improved.…”

“…Statistical analysis: Scoring systems used to detect NAFLD were the FLI = (e 0.953 × ln (triglycerides in mg/dl) + 0.139 × BMI in kg/m² + 0.718 × ln (GGT in U/l) + 0.053 waist circumference in cm -15.745) / (1 + e 0.953 × ln (triglycerides in mg/dl) + 0.139 × BMI in kg/m² + 0.718 × ln (GGT in U/l) + 0.053 × waist circumference in cm -15.745) × 100 [23] and the NASH-Score by gaining one point each for triglycerides ≥ 200 mg/dl, AST/ALT ≤ 1, ALT ≥ 30 IU/l and GGT ≥ 30 IU/ while NASH is probable at ≥ 3 points [24]. The Homeostasis model assessment insulin resistance index (HOMA-IR) was calculated by Insulin [µU/ml] X Glucose [mmol/l] / 22.5 [33].…”

“…Two of these are the "Fatty Liver-index" (FLI) and NASH-Score. FLI is an algorithm based on Body-Mass-Index (BMI), waist circumference, triglycerides, and gamma-glutamyltransferase (GGT) while the NASH-Score predicts NASH by total cholesterol, alanine aminotransferase (ALT), AST/ALT ratio (AAR), and GGT [23,24].…”

Ezetimibe Ameliorates Atherosclerotic and Inflammatory Markers, Atherogenic Lipid Profiles, Insulin Sensitivity, and Liver Dysfunction in Japanese Patients with Hypercholesterolemia

“…In the present study, we confirmed that ezetimibe improves insulin resistance by reducing fasting IRI and HOMA-IR. The serum ALT level and the AST/ALT ratio, which are usually low in patients with fatty liver 17) , were significantly decreased and increased, respectively after ezetimibe monotherapy in patients with high basal ALT levels. Although we did not confirm fatty liver using ultrasonography or computed tomography, these results suggest that ezetimibe improves fatty liver.…”

“…The basal AST/ALT ratio, which is usually low in patients with fatty liver 17) , was significantly lower in the high ALT group than in the normal ALT group. After 12 weeks of ezetimibe treatment, the AST/ALT ratio was significantly increased in the high ALT group, whereas, conversely, that in the normal ALT group significantly decreased (Table 3).…”