Biopsy Proven Fibrosis in Non-Alcoholic Fatty Liver Disease: An Analysis of Risk Factors

Kaumudee Pattnaik; Pallavi Bhuyan; Ayaskant Singh; Shivaram P Singh; Preetam Nath; Sanjib Kar; Bijay Misra; Jayashree Rath

doi:10.1016/j.jceh.2017.12.008

Biopsy Proven Fibrosis in Non-Alcoholic Fatty Liver Disease: An Analysis of Risk Factors

J Clin Exp Hepatol. 2018 Dec;8(4):367-374. doi: 10.1016/j.jceh.2017.12.008. Epub 2018 Jan 8.

Authors

Kaumudee Pattnaik¹, Pallavi Bhuyan¹, Ayaskant Singh², Shivaram P Singh³, Preetam Nath⁴, Sanjib Kar⁵, Bijay Misra⁶, Jayashree Rath⁷

Affiliations

¹ Department of Pathology, SCB Medical College, Cuttack, Odisha, India.
² Department of Gastroenterology, IMs and SUm Hospital, Bhubaneswar, Odisha, India.
³ Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India.
⁴ Department of Gastroenterology, KIMs, Bhubaneswar, India.
⁵ Gastro Liver Care, Cuttack, India.
⁶ Institute of Gastro and Kidney Care Hospital, Bhubaneswar, India.
⁷ Department of Pathology, KIMs, Bhubaneswar, India.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. NAFLD is characterized by hepatic steatosis in absence of a significant alcohol use or other known liver disease. Non-alcoholic steatohepatitis (NASH) is a progressive form of NAFLD which deserves particular attention because it is more prone for development of fibrosis. Liver biopsy is the gold standard for diagnosis of NASH by evaluating necroinflammatory activity and stages of fibrosis. The aim of the study was to analyze liver biopsy specimens and identify risk factors associated with fibrosis in patients of NAFLD in eastern coastal India.

Methods: A total of 216 subjects with fatty liver in ultrasonography (USG) were selected for needle biopsy. Those NAFLD cases showing fibrosis in biopsy were analyzed for risk factors association.

Results: Definite NASH was diagnosed in 50 (23.14%), borderline NASH in 66 (30.55%) and not NASH in 100 (46.39%) of cases. Those patients with fibrosis (22%) were taken as cases and those without fibrosis (78%) were taken as controls for risk factor analysis. Age > 40 [odds ratio (OR) 2.01 (1.09-4.04)], female gender [OR 2.74 (1.24-6.05)], body mass index (BMI) > 23 [OR 15.36 (4.59-51.37)] and moderate fatty change in USG [OR 1.89 (1.01-3.62)] were observed as risk factors for progression to fibrosis in NAFLD cases.

Conclusion: Older age, females, obesity and moderate fatty liver on USG are risk factors for development of fibrosis in patients with NAFLD. Patients with these risk factors should be selected for liver biopsy and to be kept for close follow-up.

Keywords: ALK, alkaline phosphatase; ALT, alanine transferase; AST, aspartate transferase; BMI, body mass index; CI, confidence interval; FBS, fasting blood sugar; H&E, Hematoxylin & Eosin; HDL, high density cholesterol; IR, insulin resistance; LDL, low density cholesterol; NAFLD; NAFLD, non-alcoholic fatty liver disease; NAS, NAFLD Activity Score; NASH, non-alcoholic steatohepatitis; OR, odds ratio; PPBS, post-prandial blood sugar; Tc, total cholesterol; Tg, triglyceride; USG, ultrasonography; fibrosis; liver biopsy; risk factors; ultrasonography.