ECE2017 Eposter Presentations: Diabetes, Obesity and Metabolism Obesity (81 abstracts)
Suboptimal prediction of advanced fibrotic liver disease by standard non-invasive scoring systems in obese patients undergoing bariatric surgery
Niall Dempster 1, , Michael Watson 4 , Rachel Franklin 1 , Maciej Juszczak 2 , Lisa Rickers 3 , Caroline Fletcher 3 , Bruno Sgromo 3 , Richard Gillies 3 , Jeremy Cobbold 4 , Leanne Hodson 1 , Jeremy Tomlinson 1 & John Ryan 4
1Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; 2Department of Vascular Surgery, John Radcliffe Hospital, Oxford, UK; 3Department of Bariatric Surgery, Churchill Hospital, Oxford, UK; 4Department of Hepatology, Churchill Hospital, Oxford, UK.
Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD), is present in over 90% of obese patients undergoing bariatric surgery. It is a spectrum of pathology ranging from steatosis through to inflammation (Non-Alcoholic Steatohepatitis, NASH) and fibrosis. Bariatric surgery is currently the most effective treatment for NAFLD, but post-operative hepatic decompensation can occur and therefore pre-operative stratification of liver disease severity is beneficial. Several non-invasive scoring systems have been developed to stage NAFLD, but validation in the bariatric surgical population has been limited.
Methods: 135 consecutive patients who underwent bariatric surgery in a tertiary referral unit from November 2014 to December 2016 were identified and the following NAFLD risk scores calculated: AST/ALT, APRI, BARD, Fib4 and NAFLD Fibrosis Score (NFS). All patients had an intraoperative liver biopsy performed for accurate histological staging of disease. Logistic regression analysis was used to determine their efficacy in detecting NASH (NAFLD Activity Score ≥5), advanced fibrosis (Brunt F3/4) and cirrhosis (F4) identified on liver biopsy using R software.
Results: BARD and AST/ALT were independent predictors of NASH on multivariate logistic regression analysis. However, only AST/ALT ratio was significant in the final model (AST/ALT P=0.04, BARD P=0.08). AUROC for the regression model which included AST/ALT and BARD was 0.75. BARD and APRI were significant factors (P=0.03, P=0.04) on stepwise regression for F3/4 cirrhosis and they were included in the final model, which had AUROC 0.73. Only Fib4 scoring was independently associated with cirrhosis (F4) on multivariate regression analysis (P=0.04) and AUROC for the final model incorporating this factor was 0.70. In contrast to observations in non-bariatric patients, the NFS was of limited value and not an independent factor in predicting NASH, advanced fibrosis or cirrhosis.
Conclusion: Currently used non-invasive serum-based scoring systems have only a modest predictive value for staging the severity of NAFLD in patients undergoing bariatric surgery. Intra-operative liver biopsy to detect and subsequently manage advanced liver disease therefore remains of value. There is a need to develop and validate non-invasive biomarkers of disease that offer better predictive value in the bariatric population.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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