Fibro-scan Based Score and Novel Noninvasive Serum Marker, FGF-21, to Assess Liver Fibrosis in Morbidly Obese Patients with Nonalcoholic Fatty Liver Disease

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of liver disease in the Western world, affecting up to 20-30% of the general adult population. It is a growing public health problem, because of the increasing prevalence of the pathologies that contribute to its development such as obesity and inflammation status. Aim of the Work This prospective cohort study aims to develop and validate noninvasive scoring system for assessment liver fibrosis in morbidly obese patients with NAFLD. Subjects and Methods This is a Prospective cohort study, was carried out on 50 morbidly obese patients selected from endocrinology department, AIN SHAMS UNIVERSITY, through a period of six months. Results The main results of the study revealed that: There were 32(64.0%) male and 18(36.0%) female with mean age 40.48 (± 12.16) SD. There were 14(28.0%) between (20 -30), 11(22.0%) between (30-40), 9(18.0%) between (40-50) and 16(32.0%) ≥50. Mean Weight (Kg) was 106.6 (± 13.31) SD with range (82.50 – 145.5), mean Height (Cm) was 171.7 (± 6.25) SD with range (158.0 – 185.0), mean BMI (Kg/m2) was 36.17 (± 4.15) SD with range (29.30 – 43.40), mean Waist circumference 113.1 (± 8.64) SD with range (92.0 – 129.0). There were 37(74.0%) with Comorbidity. 10(20.0%) have DM, 11(22.0%) have HTN, 11(22.0%) have CDK and 5(10.0%) have COPD. mean Hb was 12.24 with range (11.0 – 13.50), mean Plts was 193.2 with range (151.0 – 250.0), mean WBCs with range (4.70 – 8.20), mean AST was 85.20 with range (21.0 – 210.0), mean ALT was 86.64 with range (15.0 – 212.0), mean Cholesterol was 181.4 with range (122.0 – 248.0), mean Triglycerides was 156.3 with range (12.0 – 294.0), mean LDL was 119.1 with range (61.0 – 193.0), mean HDL was 61.32 with range (23.0 – 96.0), mean GGT (U/l) was 18.22 with range (7.0 – 33.0), mean HBA1C was 5.72 with range (4.70 – 9.30), mean Fasting blood sugar was 101.8 with range (81.0 – 155.0) and mean Uric acid was 6.23 with range (4.0 – 10.10). Regarding ultrasound outcome there were 33(66.0%) have Gallbladder wall blurring, 34(68.0%) have Portal vein wall blurring, 42(84.0%) have Hepatic vein blurring and 50 (100.0%) have fatty liver. Regarding fibrosis grade there were 12(24.0%) F1, 17(34.0%) F2, 18(36.0%) F3 and 3(6.0%) F4. Conclusion That the combination of Fibroscan and, APRI, FGF-21 and FIB-4 methods provides a valuable approach for assessing liver fibrosis in NAFLD patients. This can eliminate the need for liver biopsy in patients without clear indication. In addition, several recent studies have also validated the used of non-invasive markers in the diagnosis of NAFLD. The establishment of a national program for the recognition of NAFLD is therefore essential to reduce the risk of liver disease progression.