title: Serum ferritin is a discriminant marker for both fibrosis and inflammation in histologically proven non-alcoholic fatty liver disease patients.
abstract: BACKGROUND
  Differentiation between steatosis and non-alcoholic steatohepatitis (NASH) in non-alcoholic fatty liver disease (NAFLD) is important as NASH progress to cirrhosis. No specific laboratory/imaging technique exists either to diagnose NASH or to select patients for liver biopsy.
  
  
  METHODS
  We evaluated serum ferritin and the features of metabolic syndrome with respect to histological inflammation and/or fibrosis in NAFLD patients. The Kleiner scoring system was used to classify NAFLD in consecutive liver biopsies. One hundred and eleven patients: median age 52.6, 64 males, obesity 62, diabetes mellitus (DM) 58, arterial hypertension 26 and hyperlipidaemia 40%.
  
  
  RESULTS
  Histologically, 40.7 had fatty liver, 30.6% had borderline NASH, 28.7% had NASH and 11% had cirrhosis. Multivariate regression showed that diabetes, serum ferritin concentrations, body mass index (BMI) and AST were independently associated with NASH: together, the areas under the receiver operating characteristic (AUROC) was 0.91 (95% confidence interval 0.86-0.96); fibrosis was associated with ferritin concentrations and BMI: AUROC 0.87, portal inflammation with ferritin and DM: AUROC 0.82, while lobular inflammation was associated with BMI, DM and ferritin: AUROC 0.85.
  
  
  CONCLUSIONS
  Serum ferritin concentrations and BMI are strongly associated with fibrosis, portal and lobular inflammation in NAFLD patients. Both ferritin and BMI are potential discriminant markers to select patients for liver biopsy and are associated with inflammation and fibrosis.
authors: The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK.
authors: Pinelopi
authors: P
authors: Manousou
authors: George
authors: G
authors: Kalambokis
authors: Federica
authors: F
authors: Grillo
authors: Jennifer
authors: J
authors: Watkins
authors: Elias
authors: E
authors: Xirouchakis
authors: Maria
authors: M
authors: Pleguezuelo
authors: Gioacchino
authors: G
authors: Leandro
authors: Vasiliki
authors: V
authors: Arvaniti
authors: Giacomo
authors: G
authors: Germani
authors: David
authors: D
authors: Patch
authors: Vincenza
authors: V
authors: Calvaruso
authors: Dimitri P
authors: DP
authors: Mikhailidis
authors: Amar P
authors: AP
authors: Dhillon
authors: Andrew K
authors: AK
authors: Burroughs
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D005260:Female; D005293:Ferritins / Q000097:blood*; D006505:Hepatitis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications; D006973:Hypertension / Q000097:blood / Q000150:complications; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D016015:Logistic Models; D008131:London; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D049451:Nomograms; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005293:Ferritins; D001219:Aspartate Aminotransferases