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Copyright ©The Author(s) 2021.
World J Gastroenterol. Jun 21, 2021; 27(23): 3238-3248
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3238
Table 1 Role of noninvasive liver function testing in clinical progression of nonalcoholic steatohepatitis
Sr. No.
Indicator
Ref.
Journal
Year
Results
1BilirubinDemir et al[24]PLoS One2013Total bilirubin was identified as a significant predictor of advanced fibrosis and used to construct the NIKEI score which can reliably exclude advanced fibrosis in subjects with NAFLD
Ratziu et al[25]BMC Gastroenterol2006FibroTest which includes total bilirubin in its panel is a simple and noninvasive quantitative estimate of liver fibrosis which reliably predicts advanced fibrosis
Adams et al[11]J Hepatol2005Hepascore, a model of 4 serum markers plus age and sex provides clinically useful information regarding different fibrosis stages among hepatitis C patients
2Serum AST/ALTMartin-Rodriguez et al[20]Medicine (Baltimore)2017Serum ALT level is the most predictive laboratory investigation for the NAFLD. The AST-ALT Ratio (AAR) is higher in increasing liver fat content, fibrosis and other metabolic derangements like diabetes and dyslipidemia
Enomoto et al[21]World J Gastroenterol2015AAR > 1 is consistent with NASH
Arora et al[22]J Clin Exp Hepatol2012AAR > 1 may indicate the progression of NAFLD and aid in diagnosing liver fibrosis
Shah et al[17]Clin Gastroenterol Hepatol2009The FIB-4 score composed of age, AST and ALT and platelet counts is an invasive and inexpensive method which has shown superiority to BAAT (BMI, Age, ALT, Triglycerides) and BARD (BMI, AST: ALT, Diabetes) scores in monitoring the progress of NASH
McPherson et al[18]Eur J Gastroenterol Hepatol2013The FIB-4 score was reliable in ruling out advanced fibrosis in patients with histological evidence of NAFLD who had normal or increased levels of ALT, thus decreasing the need for invasive liver biopsy
3Platelet CountEnomoto et al[21]World J Gastroenterol2015A reducing level of platelet count has been well documented in advancing liver diseases
Kawamura et al[26]Hepatol Int2015FSN score of 17 variables including platelet count could accurately predict fibrotic stage and discriminates patients with advanced fibrosis of NASH
Kessoku et al[27]World J Gastroenterol2014PLALA Score is a very unique scoring system as it has shown usefulness in distinguishing cirrhosis in NAFLD when compared with most fibrosis scoring systems
Abdel-Razik A et al[47]Eur J Gastroenterol2016MPV is a noninvasive novel marker to predict advanced disease as it was increased in NASH patients and advance liver fibrosis
Cengiz et al[48]Eur J Gastroenterol2015Red cell volume distribution width-to-platelet ratio was both correlated and able to predict liver fibrosis. It may reduce liver biopsy in NAFLD
4Fasting blood glucose and glycosylated proteinPelusi et al[49]PLoS One2016Nonalcoholic steatohepatitis with greater degree of fibrosis was discovered in patients with insulin resistance. Type 2 diabetes in patients with NAFLD tends to drive the rate of fibrosis
5Hyaluronic acid (hyluroante) tissue metaloproteinaseArora et al[22]J Clin Exp Hepatol2012European Liver Fibrosis score ELF scoring system has indicators for cellular matrix activities including Hyaluronic acid (hyluroante) tissue metalloproteinase which has been indicative of fibrosis
6Type IV collagenNakamura et al[30]J Diabetes Investig2013NAFIC Score including type IV collagen 7S and Modified NAFIC score were proven to be clinically useful in screening for NASH in NAFLD patients
7Glycosylated Albumin to Glycosylated Hemoglobin RatioHu et al[28]World J Gastroenterol 2014HOMA-IR score indicates NAFLD progression using a formula that involves insulin levels and fasting glucose to calculate insulin resistance. The score has a high sensitivity for NASH
Stål[29]World J Gastroenterol 2015NAFLD fibrosis score, a non- invasive score which includes the presence of diabetes or impaired fasting glucose is the most predictive of mortality in NASH as compared to NAFL patients
8Prothrombin timeAssy et al[31]World J Gastroenterol2005Increase prothrombin time is usually associated with cirrhotic changes
9AlbuminBazick et al[5]Diabetes Care2015Serum albumin gets reduced in patients progressing to NASH and fibrosis from NAFLD
Table 2 Role of imaging techniques in clinical progression of nonalcoholic steatohepatitis
Sr. No.
Imaging modality
Ref.
Journal
Year
Results
1UltrasoundSanyal[32]Gastroenterology2002US is currently the preferred method in United States for screening asymptomatic patients with elevated liver enzymes and suspected NAFLD with sensitivity in detecting steatosis varying between 60%–94%
2Magnetic Resonance ElastographyIijima et al[35]Hepatol Res2007Magnetic resonance elastography has excellent diagnostic accuracy with sensitivity and specificity of 98% and 99%, respectively, for detecting all grades of fibrosis
Huwart et al[36]Gastroenterology2008Magnetic resonance elastography was associated with a higher technical success rate than US elastography
3FibroscanWong et al[39]Gut2012Transient elastography had shown good results in patients with NAFLD. It is a non-invasive method of assessing liver fibrosis which can be performed at the bedside or in the outpatient clinic
Wong et al[40]Hepatology2010Transient elastography had shown good results in patients with NAFLD. It is a non-invasive method of assessing liver fibrosis which can be performed at the bedside or in the outpatient clinic
Ratziu et al[43]Gastroenterology2005Fibroscan has now been validated in NAFLD, and represents a useful tool for rapid, non-invasive assessment of liver fibrosis and determining the need for biopsy. Nonetheless, fibroscan values should be interpreted in consonance with clinical, biological, and morphological data
Table 3 Nonalcoholic steatohepatitis activity score; steatosis, activity, and fibrosis score; and brunt grading and staging systems
NASH activity score
Steatosis, activity and fibrosis score
Brunt grading and staging
Steatosis grade 0-3Steatosis S0-S3 Grade 1 (Mild)
Lobular inflammation 0-3Activity A1-A3Grade 2 (Moderate)
Ballooning 0-2Lobular inflammation 0-2Grade 3 (Severe)
Fibrosis 0-4 (grade 1 has subgrade A, B, C)Ballooning 0-2Stages fibrosis
Fibrosis F0-F4Stage 1-4