Simple biochemical parameters and a novel score correlate with absence of fibrosis in patients with nonalcoholic fatty liver disease.
OBJECTIVE
Liver biopsy is the gold standard for detecting fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Due to limitations of biopsy, various combinations of serum markers have been studied to predict liver fibrosis; many of these are patented and expensive, thereby restricting their evaluation. We prospectively evaluated the correlation of commonly used serum markers with fibrosis in Indian patients with NAFLD.


METHODS
Fifty-one patients (age 50.4 [SD 11.5] years) with biopsy-proven NAFLD underwent estimation of platelet count, total bilirubin, AST, ALT, serum albumin, γ-glutamyl transpeptidase (GGT), prothrombin time, serum cholesterol, triglycerides, α2-macroglobulin (A2M), apolipoprotein A1 (Apo A1), and haptoglobin. FIB-4, AST/platelet ratio index (APRI), and AST/ALT ratio were calculated and correlated with fibrosis (NAS-II score) on liver biopsy.


RESULTS
Thirty-eight (74.5 %) patients had inflammation and 48 (94.1 %) had ballooning degeneration on histology; 29 had fibrosis, of whom 11 had ≥F2 fibrosis. High GGT (odds ratio [OR] 8.4 [1.85-38.10]; p = 0.007, area under the curve [AUROC] 0.65), low platelet count (OR 7.57 [1.83-31.45]; p = 0.001, AUROC 0.833), and low Apo A1 (OR 12.04 [2.98-47.3]; p = 0.0002, AUROC 0.76) were associated with advanced fibrosis on multiple logistic regression; a novel score formulated by assigning 1 point for an abnormal value for each of these parameters correlated with absence of fibrosis (p = 0.0001; OR 0.102 [95 % confidence interval (CI) CI 0.025-0.418]), with negative predictive value of 94.29 % [95 % CI 80.81 to 99.13].


CONCLUSIONS
A score using simple markers including GGT, Apo A1, and platelet count correlated with absence of liver fibrosis in patients with NAFLD.
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Akash
A
Shukla
Department of Clinical Pharmacology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Swapnali
S
Kapileswar
Department of Clinical Pharmacology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Nithya
N
Gogtay
Department of Pathology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Amita
A
Joshi
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Prashant
P
Dhore
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Chirag
C
Shah
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Philip
P
Abraham
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India. shobna.bhatia@gmail.com.
Shobna
S
Bhatia
D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000473:pathology*; D010976:Platelet Count; D011446:Prospective Studies; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood*
D016632:Apolipoprotein A-I; D015415:Biomarkers; D005723:gamma-Glutamyltransferase
Cirrhosis of liver; Fibrotest; Nonalcoholic steatohepatitis; Obesity