title: Serum ferritin levels predict histological severity in patients with nonalcoholic fatty liver disease in India.
abstract: OBJECTIVE
  The aims of the study were to determine the levels of serum ferritin which predict fibrosis in Indian patients with nonalcoholic fatty liver disease (NAFLD) and to establish correlation between Fibroscan values and serum ferritin levels.
  
  
  METHODS
  The clinical, biochemical, radiologic, and histological findings of consecutive adult NAFLD patients accessed at a tertiary care center over a 3-year period were analyzed. Those with concurrent liver diseases were excluded. Fifty-five of 250 NAFLD patients with fatty liver on ultrasound and raised enzymes (>40 IU/L) underwent liver biopsy. Patients were stratified into two groups based on their histological stage steatosis (with or without inflammation) but no fibrosis and nonalcoholic steatohepatitis (NASH) with fibrosis/cirrhosis. Serum ferritin levels were measured at the same time as getting liver biopsy. Fibroscan was carried out in each of these patients. These were compared with 50 age- and sex-matched controls with normal ultrasound, liver enzymes, and no history of alcohol. Student's t test was used as the test for significance.
  
  
  RESULTS
  Fifty-five NAFLD patients diagnosed on ultrasound and with raised enzymes underwent biopsy. Steatosis (with or without inflammation, but no fibrosis/ballooning) was seen in 35 patients, fibrosis/ballooning in 14 patients, and cirrhosis in 6 patients. Mean ferritin levels in groups with nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) were 39.4 and 72.7 ng/mL, respectively (p < 0.001). The mean ferritin levels in NAFLD and controls were 51.2 and 35.2 ng/mL, respectively (p < 0.05). The area under the curve (AUC) of serum ferritin at value 48.0 ng/mL was 0.779. The coefficient of correlation between Fibroscan and serum ferritin levels was 0.9864 while that with alanine transaminase and aspartate aminotransferase was 0.69. Serum ferritin at the cutoff of 48 ng/mL differentiated significantly patients with fibrosis and higher Fibroscan levels.
  
  
  CONCLUSIONS
  Serum ferritin was low in Indian individuals, and levels even within apparently normal range indicated fibrosis and cirrhosis. A cutoff level of 48.0 IU/mL distinguished fibrosis in NAFLD. Fibroscan correlated well with serum ferritin levels.
authors.affiliation: Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Dr. Babasaheb Ambedkar Road, Sion West, Sion, Mumbai, 400 022, India, pathik269@gmail.com.
authors.forename: Pathik
authors.initials: P
authors.lastname: Parikh
authors.forename: Jatin
authors.initials: J
authors.lastname: Patel
authors.forename: Meghraj
authors.initials: M
authors.lastname: Ingle
authors.forename: Prabha
authors.initials: P
authors.lastname: Sawant
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood*; D005355:Fibrosis; D006801:Humans; D007194:India; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis* / Q000473:pathology*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D005293:Ferritins