Non-invasive assessment of liver fibrosis in patient with non-alcoholic fatty liver disease

Abstract

Background: Fatty (change of) liver, not elsewhere classified (ICD-10: K-76.0) includes non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). 10-15 years after the formation of steatosis in liver cells, complications such as fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) occur in the liver. NAFLD has an estimated global prevalence rate of 25.4% worldwide, 30.45% in South America, and 13.48% in Africa, and up to 30% in Asia. Liver elastography is a non-invasive, pain-free test that can accurately assess the degree of fat accumulation and fibrosis in liver cells. In recent years, various non-invasive methods have been used to evaluate liver fibrosis in the diagnosis of NAFLD. For example; aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzyme ratio, FIB-4 score, and markers such as aspartate aminotransferase-to-platelet ratio index (APRI) are used to evaluate the degree of fibrosis. Non-invasive methods for monitoring patient with NAFLD have multiple benefits in clinical practice. Aim: We evaluated the diagnostic performance of tools for assessment of hepatic fibrosis in patients with NAFLD. Materials and Methods: The study was conducted using a quantitative method using a hospital-based cross sectional study. After discussion with the Ethics Subcommittee of the Mongolian National University of Medical Sciences and obtaining ethical approval, the adult population who underwent preventive examination at Kharaa Hospital in Bugat, China between October 15, 2023 and November 15, 2023, a total of 201 participants diagnosed with fatty liver by laboratory and instrumental tests were selected by targeted sampling method. Liver steatosis and fibrosis were assessed by liver elastography (FibroScan 502) in all study participants. Differential diagnosis of alcoholic fatty liver disease and NAFLD was performed using the AUDIT test issued by the National Institute of Alcohol Abuse and Alcoholism. Statistical processing was done using Microsoft Excel and SPSS 20 software. Results: 201 people aged 18-76 participated in the study, and the average age was 47±11 years. Among them, 117 (58.2%) men and 84 (41.8%) women participated. By elastography, there were 24 (12%) participants with F0 grade, 22 (11%) participants with F1 grade, 61 (30%) participants with F2 grade, 20 (10%) participants with F3 grade, and 74 participants with (37%) F4 grade. For detection (F3 and F4), using APRI, FIB-4 and AsAT/AlAT markers to construct ROC curves, FIB-4 marker was the most effective. The optimal cut-off value for FIB-4 was 1.337, with a sensitivity of 79.8% and a specificity of 38.3%. Conclusion: It is possible to evaluate the degree of liver fibrosis in the NAFLD using the FIB-4 score method.