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Fibroscan-Based Score to Predict Significant Liver Fibrosis in Morbidly Obese Patients with Nonalcoholic Fatty Liver Disease

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Abstract

Background

The prevalence rate of nonalcoholic fatty liver disease (NAFLD) has been reported in 74 to 90% of morbidly obese patients. This study aims to develop a scoring system that predicts significant liver fibrosis in morbidly obese patients.

Methods

This prospective cohort study involved 123 morbidly obese patients who underwent metabolic surgery at Taipei Medical University Hospital between October 2016 and June 2018. Wedge liver biopsy was performed during surgery, and significant liver fibrosis was defined as a fibrosis score ≧ 2. Ultrasonography and transient elastography were performed prior to surgery to assess the risk factors associated with significant liver fibrosis.

Results

Mean patient age was 35.5 years, mean body mass index (BMI) was 40.6 kg/m2, and 87 (70.7%) were female. Fibrosis staging revealed 28 (22.8%) at stage 2, 14 (11.4%) at stage 3, and 2 (1.6%) at stage 4. Patients were then separated into training (n = 73) and validation (n = 50) cohorts. Multivariate analysis revealed a liver stiffness measurement (LSM) > 7 kPa and aspartate aminotransferase/platelet ratio index (APRI) > 0.40 as independent factors associated with significant liver fibrosis among the training cohort. Fibroscan-base score weighted sum of (1 for presence of APRI > 0.40) + (2 for presence of LSM > 7 kPa) yielded the highest area under receiver operating curve (0.854, P = 0.0001; 0.785, P = 0.0002) compared with other non-invasive markers in the training and validation cohorts, respectively.

Conclusion

We developed a simple, clinical scoring system incorporating Fibroscan and APRI to predict significant liver fibrosis in morbidly obese patients.

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Abbreviations

LSM:

liver stiffness measurement

CAP:

controlled attenuation parameter

HTN:

hypertension

DM:

diabetes mellitus

BMI:

body mass index

SD:

standard deviation

M:

male

F:

female

WC:

waist circumference

LDL:

low-density lipoprotein

TG:

triglyceride

AST:

aspartate aminotransferase

ALT:

alanine aminotransferase

GGT:

gamma-glutamyltransferase

HOMA-IR:

homeostasis model assessment of insulin resistance

APRI:

aspartate aminotransferase/platelet ratio index

FLI:

fatty liver index

NAFLD-FS:

nonalcoholic fatty liver disease fibrosis score

FIB-4:

score Fibrosis-4 score

US:

ultrasonographic

SAPI:

splenic arterial pulsatility index

TC:

training cohort

VC:

validation cohort

NAFLD:

nonalcoholic fatty liver disease

NASH:

nonalcoholic steatohepatitis

OR:

Odds ratio

CI:

confidence interval

HBV:

hepatitis B virus

HCV:

hepatitis C virus

HCC:

hepatocellular carcinoma

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Funding

Declaration of funding interests: This study was supported by grants from the Ministry of Science and Technology (MOST 105–2314-B-038-006; MOST 106–2314-B-038-030; MOST 107–2314-B-038-064;MOST 108–2314-B-038-055).

Author information

Authors and Affiliations

  1. Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Wei-Yu Kao, Chun-Chao Chang & Yu-Jia Chang

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    Wei-Yu Kao, Sheng Uei Fang, Jui-Hsiang Tang & Chun-Chao Chang

  3. Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Wuxing Street, Xinyi District, Taipei City, 110, Taiwan

    Wei-Yu Kao, Sheng Uei Fang, Jui-Hsiang Tang & Chun-Chao Chang

  4. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Wei-Yu Kao & Chien-Wei Su

  5. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Wei-Yu Kao & Chien-Wei Su

  6. Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan

    I-Wei Chang & Chi-Long Chen

  7. Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    I-Wei Chang & Chi-Long Chen

  8. Departments of Pathology and Laboratory Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    I-Wei Chang

  9. Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Yu-Jia Chang

  10. Cancer Research Center, Taipei Medical University Hospital, Taipei, Taiwan

    Yu-Jia Chang

  11. Division of Digestive Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan

    Weu Wang

  12. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Weu Wang

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  1. Wei-Yu Kao
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Contributions

Wei-Yu Kao: performed abdominal sonography, provide the study concept and design, performed analysis and interpretation of data, and drafted the manuscript; I-Wei Chang: reviewed liver biopsy, contributed to study concept and design, and offered valuable discussion and support; Chi-Long Chen: reviewed liver biopsy, contributed study concept and design, and offered valuable discussion and support; Sheng Uei Fang: performed abdominal sonography and transient elastography, contributed to study concept and design, and offered valuable discussion and support; Chien-Wei Su: contributed to study concept and design, and offered valuable discussion and support; Jui-Hsiang Tang: contributed to study concept and design, and offered valuable discussion and support; Chun-Chao Chang: performed transient elastography, contributed to study concept and design, and offered valuable discussion and support Yu-Jia Chang: contributed to study concept and design, and offered valuable discussion and support; Weu Wang: performed metabolic surgery, contributed to study concept and design, and offered valuable discussion and support.

Corresponding authors

Correspondence to Yu-Jia Chang or Weu Wang.

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Kao, WY., Chang, IW., Chen, CL. et al. Fibroscan-Based Score to Predict Significant Liver Fibrosis in Morbidly Obese Patients with Nonalcoholic Fatty Liver Disease. OBES SURG 30, 1249–1257 (2020). https://doi.org/10.1007/s11695-019-04192-w

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  • DOI: https://doi.org/10.1007/s11695-019-04192-w

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