DIAGNOSTIC ACCURACY OF THE NON-INVASIVE MARKERS NFLS, NI-NASH-DS, AND FIB-4 FOR ASSESSMENT OF DIFFERENT ASPECTS OF NON-ALCOHOLIC FATTY LIVER DISEASE IN INDIVIDUALS WITH OBESITY: CROSS-SECTIONAL STUDY

NI-NASH-DS e FIB-4 para avaliação de diferentes aspectos da doença hepática gordurosa não-alcoólica em indivíduos com obesidade: estudo transversal

HIGHLIGHTS

•In a bariatric population, more than 90% of the patients presented with histopathological steatosis and some degree of fibrosis, whereas over 20% had active NASH.

•FIB-4 score had high overall accuracy in assessing the presence of advanced liver fibrosis in individuals with obesity.

•NFLS score was moderately accurate for the assessment of hepatic steatosis in individuals with obesity.

•NI-NASH-DS was moderately accurate for the assessment of NASH in individuals with obesity.

ABSTRACT

Background:

Non-invasive markers have been developed to assess the presence and severity of liver abnormalities related to non-alcoholic fatty liver disease (NAFLD).

Objective:

To analyze the diagnostic accuracy of non-invasive NAFLD markers (NAFLD liver fat score [NLFS], non-invasive non-alcoholic steatohepatitis detection score [NI-NASH-DS] and fibrosis score based on four variables [FIB-4]) in individuals with obesity undergoing bariatric surgery.

Methods:

A descriptive retrospective cross-sectional study was carried out enrolling 91 individuals who underwent bariatric surgery at a tertiary-level public university hospital. Non-invasive NAFLD markers were calculated using laboratory tests, clinical and anthropometric variables and diagnostic accuracy tests were calculated comparing them in relation to the gold-standard test for this analysis (histopathological evaluation).

Results:

A total of 85.7% of the participants were female and mean age was 39.1±9.8 years. The average body mass index was 38.4±3.6 kg/m². At histopathological examination, 84 (92.3%) patients presented with steatosis, 82 (90.1%) with some type of fibrosis; 21 (23.1%) patients were diagnosed with NASH according to the NAFLD activity score criteria. The overall accuracy of NLFS score was 58.2% for general hepatic steatosis and 61.5% for moderate to severe steatosis. The overall accuracy of FIB-4 was 95.4% for advanced fibrosis. NI-NASH-DS had a 74.7% overall accuracy for NASH.

Conclusion:

In a population of individuals with obesity, the FIB-4 score had high overall accuracy in assessing the presence of advanced liver fibrosis, whereas the NFLS and NI-NASH-DS had moderate accuracies for the assessment of steatosis and NASH, respectively.

Keywords:
Non-alcoholic fatty liver disease; obesity; liver function tests; fatty liver; biomarkers