Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2021; 13(5): 571-583
Published online May 27, 2021. doi: 10.4254/wjh.v13.i5.571
Combination of type IV collagen 7S, albumin concentrations, and platelet count predicts prognosis of non-alcoholic fatty liver disease
Miwa Kawanaka, Ken Nishino, Katsunori Ishii, Tomohiro Tanikawa, Noriyo Urata, Mitsuhiko Suehiro, Takako Sasai, Ken Haruma, Hirofumi Kawamoto
Miwa Kawanaka, Ken Nishino, Katsunori Ishii, Tomohiro Tanikawa, Noriyo Urata, Mitsuhiko Suehiro, Takako Sasai, Ken Haruma, Hirofumi Kawamoto, Department of General Internal Medicine, Kawasaki Medical School, Okayama 700-8505, Japan
Author contributions: Kawanaka M contributed conceptualization, data curation, formal analysis, resources, software, supervision, validation and visualization; Ishii K and Nishino K contributed funding acquisition; Tanikawa T and Urata N contributed investigation; Suehiro M contributed methodology; Sasai T, Haruma K, and Kawamoto H contributed project administration; Kawanaka M wrote original draft, reviewed and edited manuscript.
Institutional review board statement: The study protocol complied with guidelines of the 1975 Helsinki Declaration and was approved by the Institutional Research Ethics Committee (approval No. 3027).
Informed consent statement: Written informed consent was obtained from all the patients.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Miwa Kawanaka, MD, PhD, Associate Professor, Department of General Internal Medicine, Kawasaki Medical School, 2-6-1, Nakasange, Kitaku, Okayama 700-8505, Japan.
Received: December 31, 2020
Peer-review started: December 31, 2020
First decision: February 13, 2021
Revised: February 25, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 27, 2021
Research background

Non-alcoholic steatohepatitis has few symptoms until it progresses; thus, it is necessary to identify non-alcoholic fatty liver disease (NAFLD) patients who will show poor prognosis.

Research motivation

The limitations of liver biopsies, such as invasiveness, poor patient tolerance, sampling variability, and high costs, are well known. Thus, there is increasing interest in developing and validating non-invasive methods for measuring liver stiffness. However, many current methods involve instruments that are not available in many institutions.

Research objectives

Serum biomarkers that can assess the progression of liver fibrosis in patients with NAFLD may serve as important tools for identifying patients with advanced fibrosis. We aimed to investigate the efficacy of non-invasive biomarkers for predicting disease progression in patients with NAFLD.

Research methods

We investigated biomarkers with predictable prognosis for NAFLD patients who underwent liver biopsy. All patients were followed-up for > 1 year.

Research results

The combination of three non-invasive biomarkers involved in NAFLD prognosis comprised platelet counts, albumin levels, and type IV collagen 7S. Our results indicate that patients with NAFLD who present with a combination of albumin levels < 3.5 g/dL, platelet counts < 15 × 104/µL, and type IV collagen 7S levels ≥ 5 ng/mL show poor prognosis. In particular, the 10-year survival rate was only 43% for patients who presented with all three factors.

Research conclusions

The combination of platelet count, albumin level, and type IV collagen 7S was useful in further predicting the prognosis of NAFLD.

Research perspectives

Studies conducted in the future should focus on assessing these biomarkers further and examining long-term prognosis.