title: Use of noninvasive markers to predict advanced fibrosis/cirrhosis in severe obesity.
abstract: BACKGROUND
  Nonalcoholic steatohepatitis is observed in 25%-55% of patients with severe obesity and in 2%-12% with bridging fibrosis or cirrhosis. There is currently no noninvasive test for the diagnosis of severe liver fibrosis before bariatric surgery.
  
  
  OBJECTIVE
  To determine the best noninvasive test for predicting advanced liver disease in patients with severe obesity.
  
  
  METHODS
  University tertiary care hospital, Brazil.
  
  
  METHODS
  A cross-sectional retrospective study was conducted with 699 patients with severe obesity undergoing bariatric surgery: 568 without a biopsy (nonbiopsy cohort) and 131 patients who had undergone an intraoperative liver biopsy. The tissues were subjected to histologic diagnosis (Brunt criteria) and classified as advanced fibrosis (stages 3 and 4) or no significant fibrosis (absence of nonalcoholic steatohepatitis and stages 1 or 2). The following predictive indices of cirrhosis were calculated in all patients: aspartate aminotransferase/alanine aminotransferase ratio (AAR), age-platelet (AP) index, aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), and hepatitis C antiviral long-term treatment against cirrhosis (HALT-C). The cutoff values, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUROCs) were calculated for patients with biopsies.
  
  
  RESULTS
  The AUROC of the AAR, AP, APRI, CDS, and HALT-C model for predicting advanced fibrosis or cirrhosis were, respectively, .522, .88, .99, .905, and .921. The calculated cutoff values, sensitivity, and specificity, respectively, were as follows: AAR: .94, .7, .45; AP 5, .7, .93; APRI .44, 1.0, .97; CDS 6, .7, .97; and HALT-C: .76, 1.0, .77.
  
  
  CONCLUSIONS
  APRI index was the best predictor of advanced liver disease in patients with severe obesity.
authors.affiliation: Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: roberto.cleva@uol.com.br.
authors.forename: Roberto
authors.initials: R
authors.lastname: de Cleva
authors.affiliation: Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Livio Fiolo
authors.initials: LF
authors.lastname: Duarte
authors.affiliation: Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Milton Roberto Furst
authors.initials: MRF
authors.lastname: Crenitte
authors.affiliation: Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Claudia Pinto Marques
authors.initials: CPM
authors.lastname: de Oliveira
authors.affiliation: Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Denis
authors.initials: D
authors.lastname: Pajecki
authors.affiliation: Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Marco Aurelio
authors.initials: MA
authors.lastname: Santo
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers
keywords: APRI index; CDC; HALT-C; Liver cirrhosis; Severe obesity