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Reliability of Non-invasive Liver Fibrosis Assessment Tools Versus Biopsy in Pre- and Post-bariatric Surgery Patients with Non-alcoholic Fatty Liver Disease

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Abstract

Purpose

Liver biopsy (LBx) remains the gold standard to assess fibrosis in non-alcoholic fatty liver disease (NAFLD). Biochemical markers are also useful, but their reliability is not clear in patients with morbid obesity. We assessed the performance of six non-invasive fibrosis assessment tools before and after bariatric surgery (BSx) using LBx.

Materials and Methods

This is a cross-sectional and prospective cohort study. LBx was performed at the time of BSx and 12-month post-operatively and assessed using the Brunt system. Clinical and biochemical measurements were collected at the same time points and six non-invasive fibrosis assessment tools were calculated.

Results

One hundred seventy patients had BSx; 79.4% female; age was 46.6 ± 9.8 years, and BMI was 48.6 ± 7.5 kg/m2. From liver histology, 88% had F0-F2 and 11.2% F3-F4. At BSx, aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 had better accuracy (0.86 and 0.88) with specificity of 96.6% and 94.0% and negative predictive values (NPV) of 88.9% and 93.7%. However, sensitivity (6.7% and 40.0%) and positive predictive values (PPV) (20.0% and 46.2%) were low. Twelve months post-surgery (n = 54), 88.9% of patients had F0-F2 and 11.1% had F3-F4. Fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) had the best accuracy (0.79 and 0.77) with specificity of 83.7% and 86.9% and NPV of 92.3% and 86.9%. However, sensitivity (25% and 0%) and PPV (12.5% and 0%) were low.

Conclusion

Overall, FIB-4, APRI, and NFS showed similar performances with higher accuracy, specificity, and NPV. Sensitivity and PPV were low. These tests are more useful at excluding advanced fibrosis.

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Acknowledgements

The authors gratefully acknowledge the significant support of Toronto Western Hospital’s Bariatric Clinic that made this work possible.

Funding

This study is funded by the Canadian Institutes for Health Research. Operating Grant MOP 126139. Partly funded by educational grant from Government of Kuwait.

Author information

Authors and Affiliations

  1. Toronto General Hospital, University Health Network, Toronto, ON, M5G 2C4, Canada

    Katherine J. P. Schwenger, Maryam Alali, Yasaman Ghorbani, Sandra E. Fischer & Johane P. Allard

  2. Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada

    Yasaman Ghorbani

  3. Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada

    Sandra E. Fischer & Johane P. Allard

  4. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5S 1A8, Canada

    Sandra E. Fischer

  5. Division of General Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada

    Timothy D. Jackson & Allan Okrainec

  6. Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, M5T 2S8, Canada

    Timothy D. Jackson & Allan Okrainec

  7. Department of Nutritional Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada

    Johane P. Allard

  8. Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, Toronto, ON, 9N-973M5G 2C4, Canada

    Johane P. Allard

Authors
  1. Katherine J. P. Schwenger
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  2. Maryam Alali
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  5. Timothy D. Jackson
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  6. Allan Okrainec
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  7. Johane P. Allard
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Corresponding author

Correspondence to Johane P. Allard.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Allan Okrainec receives honoraria from Ethicon and Medtronic for speaking and teaching. Other authors declare no conflict of interest.

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Key points

• NAFLD is prevalent in those undergoing bariatric surgery.

• FIB-4, APRI, and NFS show good accuracy at assessing liver fibrosis.

• These tests are most useful at excluding advanced fibrosis.

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Schwenger, K.J.P., Alali, M., Ghorbani, Y. et al. Reliability of Non-invasive Liver Fibrosis Assessment Tools Versus Biopsy in Pre- and Post-bariatric Surgery Patients with Non-alcoholic Fatty Liver Disease. OBES SURG 33, 247–255 (2023). https://doi.org/10.1007/s11695-022-06380-7

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