Serum ferritin levels do not predict the stage of underlying non-alcoholic fatty liver disease.

BACKGROUND AND AIM: Hepatic endothelial cells release ferritin in response to increased oxidative stress and lipid peroxidation. The principal aim of this study was to determine if serum ferritin levels predict the underlying stage of non-alcoholic fatty liver disease (NAFLD). METHODS: The clinical, biochemical, radiologic and histologic findings of consecutive adult NAFLD patients accessed at a tertiary care center over a 15-year period were analyzed. Those with concurrent liver diseases were excluded. Patients were stratified into three groups based on their histologic stage of disease: simple steatosis, non-alcoholic steatohepatitis (NASH) or cirrhosis. Analysis of Variance and Tukey-Kramer Multiple Comparison tests were used to assess the relationship between serum ferritin levels and stages of NAFLD. RESULTS: 482 patients fulfilled inclusion criteria, including 60 subjects with biopsy proven simple steatosis, 28 subjects with steatohepatitis (NASH) and 20 subjects with histologic or radiologic evidence of cirrhosis. Mean serum ferritin levels were similar in all three groups (simple steatosis: 223.9 ug/L; NASH: 240.7 ug/L; cirrhosis: 271.3 ug/L; p=0.84). NAFLD-induced cirrhotic patients were significantly older, more often diabetic and hypertensive, and had more frequent evidence of splenomegaly and hepatic dysfunction. Following univariate and multivariate modeling, only AST/ALT ratio, diabetes, splenomegaly and age accurately predicted the stage of underlying NAFLD-induced liver disease. CONCLUSION: Hyperferritinemia is common in patients with NAFLD but the extent of serum ferritin elevations do not predict the stage of underlying NAFLD disease.