Correlation of Clinical and Laboratory Factors with Fibrosis in Nonalcoholic Steatohepatitis

Purpose: Nonalcoholic fatty liver disease (NAFLD) represents a wide spectrum liver damage ranging from simple steatosis to steatohepatitis (NASH), advanced fibrosis and cirrhosis. Although simple hepatic steatosis runs a benign clinical course, NASH may progress to cirrhosis in 25 percent of patients and to liver-related death in 10 percent. Multiple studies have been done to devise a scoring system based on demographic and laboratory data. The purpose of this study is to characterize the relationship between demographic, clinical and laboratory variables with the extent of liver fibrosis to better guide in the clinical evaluation of patients with NASH. Methods: We retrospectively reviewed 5 years records of all the biopsy proven NASH cases evaluated in our university medical center. We examined a total of 112 patient records and deomographic, clinical, laboratory data were collected. The extent of abnormalities of the pathology report was staged as none (stage 0), perisinusoidal or pericellular fibrosis (stage 1), periportal fibrosis (stage 2), bridging fibrosis (stage3), and cirrhosis (stage 4). Chi-square was used for the frequency variable; Kruskal-Wallis test was used for the continuous variable to test the significance of the relationship between the variables and the extent of liver fibrosis. Results: We found that 23 out of 112 were stage 0. 21 were stage 1, 33 were stage 2, 18 were stage 3, 17 were stage 4. Mean age of 112 patients was 45.4 (standard deviation, SD: 13.8) and 43% was male. Mean BMI was 37.16 (SD 11.0), 28.6% of patients had diabetes. Age (P= 0.12), sex (P= 0.83), body mass index (BMI, P= 0.86), AST (P= 0.51), diabetes (P= 0.11), LDL (P= 0.07), HDL (P= 0.27), triglyceride (P= 0.53) and creatinine (P= 0.64) did not have any significant relationship with fibrosis stage. As AST/ALT ratio (P < 0.01), INR (P < 0.01), bilirubin (P= 0.02) levels increased, the stage of fibrosis increased significantly. The decrease of ALT (P= 0.02) and cholesterol (P= 0.03) level showed significant increase of stage of liver fibrosis. On the receiver operating characteristic curve, INR equal or greater than 1.065 showed 75% of sensitivity and 78.8% of specificity for advanced fibrosis. AST/ALT ratio equal or greater than 0.83 showed 94.1% of sensitivity and 65.2% of specificity for advanced fibrosis. Conclusion: In this study we found that the levels of AST/ALT ratio, INR and bilirubin, showed a significant positive correlation with the extent of liver fibrosis. ALT and Cholesterol levels showed a negative correlation with the extent of liver fibrosis. Age, BMI and Diabetes did not show significant association with the extent of liver fibrosis.