School of Medicine and Health Sciences Poster Presentations
Poster Number
297
Document Type
Poster
Publication Date
4-2017
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) affects more than 90% of patients with morbid obesity (MO) and approximately 30% have significant liver fibrosis and/or cirrhosis. Liver biopsy is the gold standard for diagnosis of significant liver fibrosis and cirrhosis; however, several non-invasive tests have been suggested to predict the presence or absence of significant liver fibrosis and to avoid liver biopsy in these patients. The aim of this study was to determine the ability of these tests to predict significant liver fibrosis, specifically in patients with MO.
Methods:
Liver biopsies from patients with MO undergoing gastric bypass surgery were studied in retrospective sequence from 2016 to 2014 and determined by histology to show either no significant fibrosis (NSF) or significant fibrosis (SF) based on the presence of no bridges or bridges of fibrosis, respectively; to increase representation of biopsies with SF, additional biopsies with SF were added from 2013-2004. Inclusion criteria after EMR review were diagnosis of MO (BMI ³ 40 kg/m2 or > 35 kg/m2 with Diabetes or hypertension) and availability of data concerning sex, age, BMI, Diabetes, platelet count, AST, ALT and albumin within 6 months before surgery; exclusion criteria were no other potential causes of liver pathology. The non-invasive tests used to estimate SF on liver biopsy included NAFLD fibrosis, BARD, APRI (0.7 cut off) and Fib4 scores, based on combinations of age, BMI, Diabetes, AST, ALT, platelets, and albumin. Test cut-off scores for SF were set using available on-line calculators.
Results:
One hundred fifty-five patients with MO met study criteria, 31 with SF. Patients were 45 ± 11 years of age, with BMI 46.7 ± 8.6 kg/m2 and 83% female; no significant differences between patients with SF and NSF. Diabetes was more prevalent in patients with SF vs NSF (83 vs 54%, p < 0.0001). Non-invasive test results for Sensitivity and Specificity found:
NAFLD - Sensitivity 41.9% (13/31) and Specificity 86.3% (107/124);
BARD - 90.3% (28/31) 29.8% (37/124);
FIB-4 - 3.2% (1/31) 100% (124/124);
APRI - 16% (5/31) 99% (123/124).
Conclusions:
No single non-invasive test showed sufficient sensitivity and specificity to recommend it as a test to predict SF in patients with MO; however, results suggest that a combination of these non-invasive test results might improve their predictive value. Diabetes was associated with SF in patients with MO and is likely to be a risk factor for progressive liver fibrosis in these patients.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Open Access
1
Included in
Hepatology Commons, Pathological Conditions, Signs and Symptoms Commons, Pathology Commons
Performance of Non-invasive Tests to Predict Significant Liver Fibrosis in Patients with Morbid Obesity
Non-Alcoholic Fatty Liver Disease (NAFLD) affects more than 90% of patients with morbid obesity (MO) and approximately 30% have significant liver fibrosis and/or cirrhosis. Liver biopsy is the gold standard for diagnosis of significant liver fibrosis and cirrhosis; however, several non-invasive tests have been suggested to predict the presence or absence of significant liver fibrosis and to avoid liver biopsy in these patients. The aim of this study was to determine the ability of these tests to predict significant liver fibrosis, specifically in patients with MO.
Methods:
Liver biopsies from patients with MO undergoing gastric bypass surgery were studied in retrospective sequence from 2016 to 2014 and determined by histology to show either no significant fibrosis (NSF) or significant fibrosis (SF) based on the presence of no bridges or bridges of fibrosis, respectively; to increase representation of biopsies with SF, additional biopsies with SF were added from 2013-2004. Inclusion criteria after EMR review were diagnosis of MO (BMI ³ 40 kg/m2 or > 35 kg/m2 with Diabetes or hypertension) and availability of data concerning sex, age, BMI, Diabetes, platelet count, AST, ALT and albumin within 6 months before surgery; exclusion criteria were no other potential causes of liver pathology. The non-invasive tests used to estimate SF on liver biopsy included NAFLD fibrosis, BARD, APRI (0.7 cut off) and Fib4 scores, based on combinations of age, BMI, Diabetes, AST, ALT, platelets, and albumin. Test cut-off scores for SF were set using available on-line calculators.
Results:
One hundred fifty-five patients with MO met study criteria, 31 with SF. Patients were 45 ± 11 years of age, with BMI 46.7 ± 8.6 kg/m2 and 83% female; no significant differences between patients with SF and NSF. Diabetes was more prevalent in patients with SF vs NSF (83 vs 54%, p < 0.0001). Non-invasive test results for Sensitivity and Specificity found:
NAFLD - Sensitivity 41.9% (13/31) and Specificity 86.3% (107/124);
BARD - 90.3% (28/31) 29.8% (37/124);
FIB-4 - 3.2% (1/31) 100% (124/124);
APRI - 16% (5/31) 99% (123/124).
Conclusions:
No single non-invasive test showed sufficient sensitivity and specificity to recommend it as a test to predict SF in patients with MO; however, results suggest that a combination of these non-invasive test results might improve their predictive value. Diabetes was associated with SF in patients with MO and is likely to be a risk factor for progressive liver fibrosis in these patients.
Comments
Poster presented at GW Annual Research Days 2017.