Use of Non-Invasive Parameters of Non-Alcoholic Steatohepatitis and Liver Fibrosis in Daily Practice - An Exploratory Case-Control Study

Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of a metabolic syndrome. To date, liver biopsy has been the gold standard used to differentiate between simple steatosis and steatohepatitis/fibrosis. Our aim was to compare the relevance of serum non-invasive parameters and scoring systems in the staging of liver fibrosis and non-alcoholic steatohepatitis (NASH) in patients with NAFLD.Methods and FindingsA total of 112 consecutive patients diagnosed with NAFLD were included. A liver biopsy was performed on 56 patients. The Kleiner score was used for the staging and grading of the histology. Non-invasive parameters for fibrosis (hyaluronic acid; AST/ALT; fibrosis scoring indexes OELF, ELF, BARD score, APRI, NAFLD fibrosis score); and inflammation (M30 and M65 cytokeratin-18 fragments) were measured and calculated. The same analyses were performed in 56 patients diagnosed with NAFLD, who were not indicated for liver biopsy. Based on the liver histology, NASH was diagnosed in 38 patients; simple steatosis in 18 patients. A cut-off value of 750 U/L of serum M65 discriminated patients with and without NASH with a 80% sensitivity and 82% specificity (95% CI:57–95). Fibrosis stage F0–F2 was present in 39 patients; F3–F4 in 17 patients. Serum concentrations of hyaluronic acid were higher in patients with advanced fibrosis (p<0.01); a cut-off value of 25 µg/l discriminated patients with F3–F4 with a 90% sensitivity and 84% specificity from those with F0–F2 (95% CI:59–99). When applying the non-invasive criteria to those patients without a liver biopsy, NASH could only be diagnosed in 16%; however, advanced fibrosis could be diagnosed in 35% of them.ConclusionsIn patients with NAFLD, non-invasive serum parameters with a high accuracy can differentiate those patients with NASH and/or advanced fibrosis from those with simple steatosis. A substantial portion of those patients not indicated for liver biopsy might have undiagnosed advanced fibrosis.

Non‐invasive assessment of liver fibrosis in chronic viral hepatitis

“…Some non‐invasive tests for predicting F proved to be efficient in patients with nonalcoholic fatty liver disease: FibroScan is a reliable method for predicting significant liver fibrosis in nonalcoholic fatty liver disease , and HA is also useful as a biomarker of hepatic fibrosis in these patients. HA was higher in patients with nonalcoholic fatty liver disease with advanced F ( P < 0·01); a cut‐off value of 25 μg/L discriminated patients with F3–F4 with a 90% Se and 84% Sp from those with F0–F2 (95% CI: 59–99) .…”

Liver fibrosis staging using T1 mapping on gadoxetic acid-enhanced MRI compared with DW imaging

“…Recent advances in MRI techniques have led to growing interest in optimising and applying functional MRI to assess the stage of liver fibrosis. 10 Perfusion-weighted imaging has also been used to predict the stage of liver fibrosis, 11 but is limited due to a lack of standardisation of acquisition techniques, complex mathematical modelling, and breathing motion artefacts during imaging acquisition. Diffusion-weighted imaging (DWI), which is easily incorporated into a routine MRI protocol, has been used to distinguish the different stages of liver fibrosis.…”

Systematic review and meta‐analysis: non‐invasive detection of non‐alcoholic fatty liver disease related fibrosis in the obese

“…Twenty-three studies assessed diagnostic accuracy in a population with confirmed histological diagnosis of NAFLD, excluding patients with <5% steatosis. Fifteen studies (7,8,15,(28)(29)(30)32,33,35,41,43,44,46,50,51) included all recruited patients in the final analysis, regardless of histological NAFLD diagnosis. Nine of these recruited patients from obese-only cohorts.…”