BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of pre-operative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. METHODS: Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. RESULTS: The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95-98 % and a specificity of 28-48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12-22 % and a specificity of 89-97 % for major histologic findings in NAFLD/NASH. CONCLUSIONS: Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful.
BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of pre-operative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. METHODS: Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. RESULTS: The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95-98 % and a specificity of 28-48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12-22 % and a specificity of 89-97 % for major histologic findings in NAFLD/NASH. CONCLUSIONS: Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful.
Authors: Pouneh Mofrad; Melissa J Contos; Mahmadul Haque; Carol Sargeant; Robert A Fisher; Velimir A Luketic; Richard K Sterling; Mitchell L Shiffman; Richard T Stravitz; Arun J Sanyal Journal: Hepatology Date: 2003-06 Impact factor: 17.425
Authors: Paul Angulo; Jason M Hui; Giulio Marchesini; Ellisabetta Bugianesi; Jacob George; Geoffrey C Farrell; Felicity Enders; Sushma Saksena; Alastair D Burt; John P Bida; Keith Lindor; Schuyler O Sanderson; Marco Lenzi; Leon A Adams; James Kench; Terry M Therneau; Christopher P Day Journal: Hepatology Date: 2007-04 Impact factor: 17.425
Authors: Hannah Collins; Grant Beban; John Windsor; Rishi Ram; David Orr; Nicholas Evennett; Benjamin Loveday Journal: Obes Surg Date: 2020-01 Impact factor: 4.129
Authors: Iria Cebreiros López; Florentina Guzmán Aroca; Maria Dolores Frutos Bernal; Juan Antonio Luján Mompeán; Águeda Bas Bernal; Antonio Miguel Hernández Martínez; Enrique Martínez Barba; Jose Antonio Noguera Velasco; Pascual Parilla Paricio Journal: Obes Surg Date: 2017-09 Impact factor: 4.129
Authors: Maciej Walędziak; Anna Różańska-Walędziak; Piotr K Kowalewski; Michał R Janik; Krzysztof Paśnik Journal: Wideochir Inne Tech Maloinwazyjne Date: 2017-05-19 Impact factor: 1.195
Authors: G Craig Wood; Xin Chu; George Argyropoulos; Peter Benotti; David Rolston; Tooraj Mirshahi; Anthony Petrick; John Gabrielson; David J Carey; Johanna K DiStefano; Christopher D Still; Glenn S Gerhard Journal: Sci Rep Date: 2017-03-07 Impact factor: 4.379
Authors: Xin Chu; Qunyan Jin; Hui Chen; G Craig Wood; Anthony Petrick; William Strodel; Jon Gabrielsen; Peter Benotti; Tooraj Mirshahi; David J Carey; Christopher D Still; Johanna K DiStefano; Glenn S Gerhard Journal: J Transl Med Date: 2018-04-24 Impact factor: 5.531