Correlation of Hepatic Steatosis with Hepatic Fibrosis in NAFLD Patients by Fibroscan:

Rishabh Sehgal; Jyotisterna Mittal; Inderpal Singh

doi:10.47009/ajmr.2020.9.3.ME1

Rishabh Sehgal Senior Resident, Department of Gastroentrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Jyotisterna Mittal Consultant Dermatologist, Vijay Anand hospital, Ludhiana, Punjab, India
Inderpal Singh Senior Resident, Department of Medicine, Government Medical College, Patiala, Punjab, India https://orcid.org/0000-0003-4938-2276

DOI: https://doi.org/10.47009/ajmr.2020.9.3.ME1

Keywords: Fibroscan, Controlled Attenuation Parameter, Non Alcohlic Fatty Liver Disease, Hepatic Steatosis, Liver Stiffness Measurement

Abstract

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a significant cause of liver injury in the world. Transient elastography with controlled attenuation parameter (CAP) is now days commonly used as a non-invasive modality to quantify liver steatosis and stage of Fibrosis in the Liver. This study was done to the correlation of hepatic Steatosis with hepatic Fibrosis in NAFLD Patients by fibroscan. Subjects and Methods: All NAFLD patients coming to DMCH from 1/1/18 to 30/11/18 were retrospectively analysed for the presence of any correlation between Steatosis and Fibrosis using a controlled attenuation parameter (CAP) and liver stiffness measurement (kPa), respectively by Fibroscan. Patients with a history of significant alcohol intake, viral infection, severe weight loss, on TPN, on drugs like amiodarone, diltiazem, steroids were excluded. Along with this history of hypertension, diabetes and smoking were noted from the available data. Results: The mean CAP of all 446 patients was 310.58 53.55 and the mean kPa was 7.14 4.75. Overall there was a significant correlation between CAP and kPa in all NAFLD patients (p <0.000). This was also true in patients who were more than 20 years of age, who have increased levels of triglycerides and were obese. Patients with S0 steatosis had a mean kPa value of 5.33 and as the steatosis stage worsened to S3 mean kPa value also increased to a maximum of 7.63. Conclusion: Quantification of Steatosis by CAP has a significant correlation with the stage of Fibrosis, especially in patients with increasing age, obese and who have high triglyceride levels.

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References

Araújo AR, Rosso N, Bedogni G, Tiribelli C, Bellentani S. Global epidemiology of non-alcoholic fatty liver disease/non- alcoholic steatohepatitis: What we need in the future. Liver Int. 2018;38(1):47–51. Available from: https://dx.doi.org/10.1111/liv.13643.

Kalra S, Vithalani M, Gulati G, Kulkarni CM, Kadam Y, Pallivathukkal J, et al. Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT). J Assoc Physicians India. 2013;61(7):448–453.

Cho Y, Tokuhara D, Morikawa H, Kuwae Y, Hayashi E, Hirose M, et al. Transient Elastography-Based Liver Profiles in a Hospital-Based Pediatric Population in Japan. PLOS ONE. 2015;10(9):e0137239–e0137239. Available from: https://dx.doi.org/10.1371/journal.pone.0137239.

Day CP, James OFW. Steatohepatitis: A tale of two “hits”? Gastroenterol. 1998;114(4):842–845. Available from: https://dx.doi.org/10.1016/s0016-5085(98)70599-2.

Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: The multiple parallel hits hypothesis. Hepatology. 2010;52(5):1836–1846. Available from: https://dx.doi.org/10.1002/hep.24001.

Yilmaz Y. Is nonalcoholic fatty liver disease the hepatic expression of the metabolic syndrome? World J Hepatol. 2012;4(12):332–334. Available from: https://dx.doi.org/10.4254/wjh.v4.i12.332.

M M, JB H. Steatosis, Glycation and Liver Fibrosis in Patients with Diabetes. J Diabetes Metab. 2015;6(12):633– 633. Available from: https://dx.doi.org/10.4172/2155-6156.1000633.

Listenberger LL, Han X, Lewis SE, Cases S, Farese RV, Ory DS, et al. Triglyceride accumulation protects against fatty acid-induced lipotoxicity. Proc Natl Acad Sci. 2003;100(6):3077–3082. Available from: https://dx.doi.org/10.1073/pnas.0630588100.

Yamaguchi K, Yang L, McCall S, Huang J, Yu XX, Pandey SK, et al. Inhibiting triglyceride synthesis improves hepatic Steato- sis but exacerbates liver damage and Fibrosis in obese mice with nonalcoholic steatohepatitis. Hepatology. 2007;45(6):1366– 1374. Available from: https://doi.org/10.1002/hep.21655.

Wong VWS, Chan HLY, Elastography. Transient elastography. J Gastroenterol Hepatol. 2010;25(11):1726–1731. Available from: https://doi.org/10.1111/j.1440-1746.2010.06437.x.

Wong VWS, Vergniol J, Wong GLH, Foucher J, Chan HLY, Bail BL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51(2):454–462. Available from: https://dx.doi.org/10.1002/hep.23312.

Paradis V, Bedossa P. Definition and natural history of metabolic steatosis: histology and cellular aspects. Diabetes Metab . 2008;34(6):638–642. Available from: https://dx.doi.org/10.1016/s1262-3636(08)74598-1.

Tai FWD, Syn WK, Alazawi W. Practical approach to non- alcoholic fatty liver disease in patients with diabetes. Diabet Med. 2015;32(9):1121–1133. Available from: https://doi.org/10.1111/dme.12725.

Younossi ZM, Gramlich T, Matteoni CA, Boparai N, McCul- lough AJ. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol. 2004;2(3):262–265. Available from: https://dx.doi.org/10.1016/s1542-3565(04)00014-x.

Jacqueminet S, Lebray P, Morra R, Munteanu M, Devers L, Messous D, et al. Screening for Liver Fibrosis by Using a Noninvasive Biomarker in Patients With Diabetes. Clin Gastroenterol Hepatol. 2008;6(7):828–831. Available from: https://dx.doi.org/10.1016/j.cgh.2008.03.005.

Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37:917–923.

Friedrich–Rust M, Ong M, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of Transient Elastography for the Staging of Liver Fibrosis: A Meta-Analysis. Gastroenterol. 2008;134(4):960–974. Available from: https://dx.doi.org/10.1053/j.gastro.2008.01.034.

Sasso M, Miette V, Sandrin L, Beaugrand M. The controlled attenuation parameter (CAP): A novel tool for the non-invasive evaluation of steatosis using Fibroscan®. Clin Res Hepatol Gastroenterol. 2012;36(1):13–20. Available from: https://dx.doi.org/10.1016/j.clinre.2011.08.001.

Castéra L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: A 5-year prospective study of 13,369 examinations. Hepatology. 2010;51(3):828–835. Available from: https://dx.doi.org/10.1002/hep.23425.

Correlation of Hepatic Steatosis with Hepatic Fibrosis in NAFLD Patients by Fibroscan