A clinical scoring system for predicting nonalcoholic steatohepatitis in morbidly obese patients

Background. More than half of the obese patients develop nonalcoholic fatty liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in liver function in obese patients with a noninvasive liver function test. Methods. In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their liver function. Liver function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results. Median liver function capacity was 286 (IQR=141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between liver function capacity and NAS (r=−0.492; p<0.001). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver function capacity is also significantly correlated with the NASH clinical scoring system (r=−0.411; p<0.001). Conclusions. Obese patients show a diminished liver function capacity, especially those suffering from type 2 diabetes. The liver function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.

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A Noninvasive Clinical Scoring Model Predicts Risk of Nonalcoholic Steatohepatitis in Morbidly Obese Patients

Obesity Surgery ◽

10.1007/s11695-010-0118-y ◽

2010 ◽

Vol 20 (6) ◽

pp. 685-691 ◽

Cited By ~ 39

Author(s):

Alex Ulitsky ◽

Ashwin N. Ananthakrishnan ◽

Richard Komorowski ◽

James Wallace ◽

Sri Naveen Surapaneni ◽

...

Keyword(s):

Nonalcoholic Steatohepatitis ◽

Morbidly Obese ◽

Obese Patients ◽

Scoring Model ◽

Clinical Scoring

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S1900 Mitochondrial Complex III Is Decreased in Morbidly Obese Patients with Nonalcoholic Steatohepatitis

Gastroenterology ◽

10.1016/s0016-5085(08)63642-2 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-780

Author(s):

Kamran Qureshi ◽

Michelle S. Johnson ◽

Ronald H. Clements ◽

Gary A. Abrams ◽

Aimee L. Landar

Keyword(s):

Nonalcoholic Steatohepatitis ◽

Complex Iii ◽

Morbidly Obese ◽

Obese Patients ◽

Mitochondrial Complex

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Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

BMC Gastroenterology ◽

10.1186/s12876-020-01400-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sophia Marie-Therese Schmitz ◽

Andreas Kroh ◽

Tom Florian Ulmer ◽

Julia Andruszkow ◽

Tom Luedde ◽

...

Keyword(s):

Scoring System ◽

High Sensitivity ◽

Scoring Systems ◽

Obese Patients ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Nafld Fibrosis Score ◽

Histologic Evaluation ◽

Clinical Scoring ◽

Nas Score

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a frequent condition in obese patients and regularly progresses to non-alcoholic steatohepatitis (NASH) and subsequent cirrhosis. Histologic evaluation is the gold standard for grading and staging, but invasive biopsies are associated with obvious risks. The aim of this study was to evaluate different non-invasive tools for screening of NAFLD and fibrosis in obese patients. Methods In a prospective cohort study liver specimens of 141 patients were taken during bariatric surgery. Serological parameters and clinical data were collected and the following scores calculated: NASH clinical scoring system (NCS), aspartate aminotransferase to platelet ratio index (APRI), FIB-4 as well as NAFLD fibrosis score (NFS). Liver function capacity was measured preoperatively by LiMAx test (enzymatic capacity of cytochrome P450 1A2). Intraoperative liver biopsies were classified using NAFLD activity score (NAS) and steatosis, activity and fibrosis (SAF) score. Results APRI was able to differentiate between not NASH and definite NASH with a sensitivity of 74% and specificity of 67% (AUROC 0.76). LiMAx and NCS also showed significant differences between not NASH and definite NASH. No significant differences were found for NFS and Fib-4. APRI had a high sensitivity (83%) and specificity (76%) in distinguishing fibrosis from no fibrosis (AUROC = 0.81). NCS and Fib-4 also revealed high AUROCs (0.85 and 0.67), whereas LiMAx and NFS did not show statistically significant differences between fibrosis stages. Out of the patients with borderline NASH in the histologic NAS score, 48% were classified as NASH by SAF score. Conclusions APRI allows screening of NAFLD as well as fibrosis in obese patients. This score is easy to calculate and affordable, while conveniently only using routine clinical parameters. Using the NAS histologic scoring system bears the risk of underdiagnosing NASH in comparison to SAF score.

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Active Helicobacter pylori Infection is Independently Associated with Nonalcoholic Steatohepatitis in Morbidly Obese Patients

Journal of Clinical Medicine ◽

10.3390/jcm9040933 ◽

2020 ◽

Vol 9 (4) ◽

pp. 933 ◽

Cited By ~ 8

Author(s):

Michael Doulberis ◽

Simone Srivastava ◽

Stergios A Polyzos ◽

Jannis Kountouras ◽

Apostolis Papaefthymiou ◽

...

Keyword(s):

Helicobacter Pylori ◽

Nonalcoholic Steatohepatitis ◽

Liver Function Tests ◽

Gastric Biopsy ◽

Helicobacter Pylori Infection ◽

Morbidly Obese ◽

Obese Patients ◽

Nonalcoholic Fatty Liver ◽

Potential Impact ◽

Lobular Inflammation

Nonalcoholic fatty liver disease (NAFLD) emerges as an important global burden and Helicobacter pylori infection (Hp-I) has been suggested as a risk factor of NAFLD, although controversy exists. This retrospective study aimed to investigate a potential impact of active Hp-I on NAFLD severity in morbidly obese patients, subjected to bariatric surgery and gastric biopsy for documentation of Hp-I. Of 64 eligible participants, 15 (23.4%) were diagnosed with active Hp-I, showing higher rates of nonalcoholic steatohepatitis (NASH) than those without Hp-I (86.7% vs. 26.5%, respectively; p < 0.001). Concerning histological lesions, steatosis grade (p = 0.027), ballooning (p < 0.001), lobular inflammation (p = 0.003), and fibrosis stage (p < 0.001) were also more severe in Hp-I positive patients. Likewise, liver function tests, insulin resistance, dyslipidemia, and arterial hypertension were significantly higher in Hp-I positive patients. Hp-I was independently positively associated with NASH (beta = 3.27; p = 0.002), severe NASH (beta = 2.37; p = 0.018), and the presence of fibrosis (beta = 3.86; p = 0.001) in a binary regression model, after adjustment for potential confounders. In conclusion, active Hp-Ι was independently associated with NASH and fibrosis, findings offering potential clinical implication.

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Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients

Hepatology ◽

10.1002/hep.25889 ◽

2012 ◽

Vol 56 (5) ◽

pp. 1751-1759 ◽

Cited By ~ 328

Author(s):

Pierre Bedossa ◽

Christine Poitou ◽

Nicolas Veyrie ◽

Jean-Luc Bouillot ◽

Arnaud Basdevant ◽

...

Keyword(s):

Scoring System ◽

Morbidly Obese ◽

Obese Patients ◽

Liver Lesions

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Parathyroid Hormone Levels May Predict Nonalcoholic Steatohepatitis in Morbidly Obese Patients

Hepatitis Monthly ◽

10.5812/hepatmon.29697v2 ◽

2015 ◽

Vol 15 (7) ◽

Cited By ~ 3

Author(s):

Morteza Ghoghaei ◽

Foad Taghdiri ◽

Elias Khajeh ◽

Farid Azmoudeh Ardalan ◽

Mojtaba Sedaghat ◽

...

Keyword(s):

Parathyroid Hormone ◽

Nonalcoholic Steatohepatitis ◽

Morbidly Obese ◽

Obese Patients ◽

Hormone Levels

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Prevalence and Predictors of Nonalcoholic Steatohepatitis in Obese Patients Undergoing Bariatric Surgery: A Department of Defense Experience

The American Surgeon ◽

10.1177/000313481408000624 ◽

2014 ◽

Vol 80 (6) ◽

pp. 595-599 ◽

Cited By ~ 15

Author(s):

Jeffrey L. Reha ◽

Sukhyung Lee ◽

Luke J. Hofmann

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Nonalcoholic Steatohepatitis ◽

Normal Liver ◽

Multivariate Regression Analysis ◽

Common Finding ◽

Systemic Hypertension ◽

Morbidly Obese ◽

Obese Patients ◽

Increased Risk

Nonalcoholic steatohepatitis (NASH) is a silent liver disease that can lead to inflammation and subsequent scaring. If left untreated, cirrhosis may ensue. Morbidly obese patients are at an increased risk of NASH. We report the prevalence and predictors of NASH in patients undergoing morbid obesity surgery. A retrospective review was conducted on morbidly obese patients undergoing weight reduction surgery from September 2005 through December 2008. A liver biopsy was performed at the time of surgery. Patients who had a history of hepatitis infection or previous alcohol dependency were excluded. Prevalence of NASH was studied. Predictors of NASH among clinical and biochemical variables were analyzed using multivariate regression analysis. One hundred thirteen patients were analyzed (84% female; mean age, 42.6 ± 11.4 years; mean body mass index, 45.1 ± 5.7 kg/m2). Sixty-one patients had systemic hypertension (54%) and 35 patients had diabetes (31%). The prevalence of NASH in this study population was 35 per cent (40 of 113). An additional 59 patients (52%) had simple steatosis without NASH. Only 14 patients had normal liver histology. On multivariate analysis, only elevated aspartate aminotransferase (AST) (greater than 41 IU/L) was the independent predictor for NASH (odds ratio, 5.85; confidence interval, 1.06 to 32.41). Patient age, body mass index, hypertension, diabetes, hypercholesterolemia, and abnormal alanine aminotransferase did not predict NASH. NASH is a common finding in obese population. Abnormal AST was the only predictive factor for NASH.

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