A simple new way to predict advanced fibrosis in patients with nonalcoholic fatty liver disease

April 02, 2007

Certain routine demographic, clinical, and laboratory values can be used to identify advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). This method could render liver biopsy unnecessary in a large proportion of patients. These findings are published in the April issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

The prevalence of NAFLD has risen in conjunction with obesity, diabetes, and the metabolic syndrome. It is the world's most common cause of chronic liver disease and afflicts one in three American adults, and one in ten American children or adolescents. NAFLD may progress to cirrhosis, liver failure, and hepatocellular carcinoma, especially in patients with more advanced fibrosis. Liver biopsy is currently the only reliable way to determine the severity of fibrosis. However, it is an expensive, invasive procedure.

Researchers led by Paul Angulo, MD, of the Mayo Clinic Foundation in Rochester, Minnesota, sought to develop a noninvasive way to determine advanced fibrosis in NAFLD patients using routinely determined and easily available clinical and biochemical variables. They studied 733 patients who had been diagnosed with NAFLD between 2000 and 2003, and who had undergone liver biopsies. For each patient, they collected demographic, clinical, and laboratory data. They used data from 480 patients to build a statistical model that predicted advanced liver fibrosis. They then tested the model using data from the remaining 253 patients.

They found that age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. They incorporated these factors into a model that yielded a patient's NAFLD fibrosis score. When the model was applied to the validation group, it identified the presence or absence of advanced fibrosis in nearly three out of every four patients.

"By applying the NAFLD fibrosis score, liver biopsy could have been avoided in 75 percent of patients in the total cohort," the authors report. Only 25 percent of the patients, those identified as 'indeterminate,' would have needed a liver biopsy to determine severity of fibrosis.

Limitations of this study may include referral bias, since patients came from centers with a particular interest studying NAFLD, and also differences in pathologist readings. However, its strengths include a large cohort of patients from a variety of locations and backgrounds with a wide-ranging prevalence of fibrosis severity.

"In summary, we have demonstrated that a NAFLD fibrosis score constructed from routine clinical and laboratory variables can accurately predict the presence or absence of advanced fibrosis in NAFLD rendering liver biopsy unnecessary in the vast majority of patients," the authors conclude. "It has to be determined however, whether the addition of serum markers of fibrosis or imaging modalities increases the diagnostic accuracy of the NAFLD fibrosis score."

Future studies should validate their results, include patients of different ages and ethnicities, and determine the potential benefits of diagnosing advanced fibrosis using the model.
-end-
Article: "The NAFLD Fibrosis Score: A Noninvasive System that Accurately Identifies Liver Fibrosis in Patients with NAFLD." Angulo, Paul; Hui, Jason M.; Marchesini, Giulio; Bugianesi, Ellisabetta; George, Jacob; Farrell, Geoffrey C.; Enders, Felicity; Saksena, Sushma; Burt, Alastair D.; Bida, John P.; Lindor, Keith; Sanderson, Schuyler O.; Lenzi, Marco; Adams, Leon A.; Kench, James; Therneau, Terry M.; Day, Christopher P. Hepatology; April 2007; (DOI: 10.1002/hep.21496).

Wiley

Related Fibrosis Articles from Brightsurf:

One step for fibrosis, one giant leap for scleroderma
At the Medical University of South Carolina, a team of researchers has demonstrated a ''moonlighting'' role for lysyl oxidase (LOX) in scleroderma.

Cystic fibrosis: why so many respiratory complications?
Cystic fibrosis, one of the most common genetic diseases in Switzerland, causes severe respiratory and digestive disorders.

Closing in on liver fibrosis: Detailing the fibrosis process at unprecedented resolution
Today, there is no effective way to treat liver fibrosis.

Liver fibrosis 'off switch' discovered in mice
UC San Diego School of Medicine researchers identified several genetic switches, or transcription factors, that determine whether or not liver cells produce collagen -- providing a new therapeutic target for liver fibrosis.

Magnetic nanomaterials become an effective treatment against liver fibrosis
Fibrosis may affect different body organs. It develops as a reaction to long-time inflammation and is supposed to isolate the inflammation site from surrounding tissues.

Cystic fibrosis carriers are at increased risk for cystic fibrosis-related conditions
A University of Iowa study challenges the conventional wisdom that having just one mutated copy of the cystic fibrosis (CF) gene has no effects on a person's health.

Short or long sleep associated with Pulmonary Fibrosis
Scientists have discovered that people who regularly sleep for more than 11 hours or less than 4 hours are 2-3 times more likely to have the incurable disease, pulmonary fibrosis, compared to those that sleep for 7 hours in a day.

Promising steps towards a treatment for pulmonary fibrosis
Research published in the journal Science Translational Medicine on 25 September by members of the Cardiovascular Disease Mechanisms group at the MRC LMS in collaboration with Duke-NUS Medical School, National Heart Centre Singapore & National Heart and Lung Institute, Imperial College London, showed that blocking a protein called interleukin-11 (IL-11) using therapeutic antibodies can reverse the fibrosis in the lung.

Cibio knocks out cystic fibrosis
The fight against cystic fibrosis continues, targeting in particular some of the mutations that cause it.

How fibrosis develops in butterfly syndrome patients
Researchers have pinpointed how fibrosis develops in butterfly syndrome patients.

Read More: Fibrosis News and Fibrosis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.