Prevalence of nonalcoholic fatty liver disease (NAFLD) and utility of FIBROspect II to detect liver fibrosis in morbidly obese Hispano-American patients undergoing gastric bypass.
BACKGROUND
Our study describes the prevalence of nonalcoholic steatohepatitis (NASH) and liver fibrosis in Hispano-American morbidly obese patients and the utility of different serum markers to predict significant liver fibrosis in this population.


METHODS
We perform a retrospective chart review of all patients undergoing Roux-en-Y gastric bypass with routine liver biopsy performed at Valley Baptist medical center during a 24-month period (2005-2006).


RESULTS
Of 129 liver biopsies, only 25.7% had some degree of steatosis, but about 55% had NASH, and 30.9% had liver fibrosis. Of those patients with liver fibrosis, only 6.9% had moderate to severe fibrosis (stages 2-4), and only one patient had cirrhosis (0.7%). Of the 129 patients, only 92 had a FIBROspect score II in their chart, and they ranged from 9 to 95, with a mean of 28.3. Of these patients, 36 had a score less than 20, and none had significant fibrosis in their biopsy. FIBROspect II® score (cutoff <20) had a negative predictive value (NPV) of 100% (confidence interval (CI) 95%, 0.9035-1) positive predictive value (PPV) of 15% (CI 95%, 0.0838-0.2693), sensitivity of 100%, and specificity of 42% to predict stage 2 fibrosis or higher.


CONCLUSIONS
NASH and liver fibrosis are present in a high percentage of morbidly obese patients. Liver function tests and ultrasound are not reliable tests to diagnose or rule out advance liver fibrosis. The use of FIBROspect II® score in the preoperative evaluation of morbidly obese patients can rule out significant liver fibrosis (stages 2-4) and avoid the morbidities related to liver biopsy.
Guajardo-Salinas
Gustavo Eugenio
GE
Department of Surgery, University of Texas Health Science Center, San Antonio, TX 78229, USA. guajardog@uthscsa.edu
Hilmy
Ashraf
A
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000009:adverse effects; D015992:Body Mass Index; D015897:Comorbidity; D005234:Fatty Liver / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass; D006403:Hematologic Tests; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000150:complications* / Q000208:ethnology / Q000601:surgery; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D014463:Ultrasonography; D044465:White People / Q000706:statistics & numerical data
D015415:Biomarkers