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©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
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 |
1 | Bilirubin | Demir et al[24] | PLoS One | 2013 | Total 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 Gastroenterol | 2006 | FibroTest 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 Hepatol | 2005 | Hepascore, a model of 4 serum markers plus age and sex provides clinically useful information regarding different fibrosis stages among hepatitis C patients | ||
2 | Serum AST/ALT | Martin-Rodriguez et al[20] | Medicine (Baltimore) | 2017 | Serum 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 Gastroenterol | 2015 | AAR > 1 is consistent with NASH | ||
Arora et al[22] | J Clin Exp Hepatol | 2012 | AAR > 1 may indicate the progression of NAFLD and aid in diagnosing liver fibrosis | ||
Shah et al[17] | Clin Gastroenterol Hepatol | 2009 | The 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 Hepatol | 2013 | The 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 | ||
3 | Platelet Count | Enomoto et al[21] | World J Gastroenterol | 2015 | A reducing level of platelet count has been well documented in advancing liver diseases |
Kawamura et al[26] | Hepatol Int | 2015 | FSN 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 Gastroenterol | 2014 | PLALA 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 Gastroenterol | 2016 | MPV 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 Gastroenterol | 2015 | Red cell volume distribution width-to-platelet ratio was both correlated and able to predict liver fibrosis. It may reduce liver biopsy in NAFLD | ||
4 | Fasting blood glucose and glycosylated protein | Pelusi et al[49] | PLoS One | 2016 | Nonalcoholic 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 |
5 | Hyaluronic acid (hyluroante) tissue metaloproteinase | Arora et al[22] | J Clin Exp Hepatol | 2012 | European Liver Fibrosis score ELF scoring system has indicators for cellular matrix activities including Hyaluronic acid (hyluroante) tissue metalloproteinase which has been indicative of fibrosis |
6 | Type IV collagen | Nakamura et al[30] | J Diabetes Investig | 2013 | NAFIC Score including type IV collagen 7S and Modified NAFIC score were proven to be clinically useful in screening for NASH in NAFLD patients |
7 | Glycosylated Albumin to Glycosylated Hemoglobin Ratio | Hu et al[28] | World J Gastroenterol | 2014 | HOMA-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 | 2015 | NAFLD 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 | ||
8 | Prothrombin time | Assy et al[31] | World J Gastroenterol | 2005 | Increase prothrombin time is usually associated with cirrhotic changes |
9 | Albumin | Bazick et al[5] | Diabetes Care | 2015 | Serum 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 |
1 | Ultrasound | Sanyal[32] | Gastroenterology | 2002 | US 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% |
2 | Magnetic Resonance Elastography | Iijima et al[35] | Hepatol Res | 2007 | Magnetic 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] | Gastroenterology | 2008 | Magnetic resonance elastography was associated with a higher technical success rate than US elastography | ||
3 | Fibroscan | Wong et al[39] | Gut | 2012 | Transient 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] | Hepatology | 2010 | Transient 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] | Gastroenterology | 2005 | Fibroscan 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 0-3 | Steatosis S0-S3 | Grade 1 (Mild) |
Lobular inflammation 0-3 | Activity A1-A3 | Grade 2 (Moderate) |
Ballooning 0-2 | Lobular inflammation 0-2 | Grade 3 (Severe) |
Fibrosis 0-4 (grade 1 has subgrade A, B, C) | Ballooning 0-2 | Stages fibrosis |
Fibrosis F0-F4 | Stage 1-4 |
- Citation: Seen TK, Sayed M, Bilal M, Reyes JV, Bhandari P, Lourdusamy V, Al-khazraji A, Syed U, Sattar Y, Bansal R. Clinical indicators for progression of nonalcoholic steatohepatitis to cirrhosis. World J Gastroenterol 2021; 27(23): 3238-3248
- URL: https://www.wjgnet.com/1007-9327/full/v27/i23/3238.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i23.3238