NON-INVASIVE TOOLS TO PREDICT FIBROSIS IN METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD). THE RESULTS OF THE PROSPECTIVE STUDY FROM THE HEPATOLOGY TERTIARY CENTER FROM IASI

  • V.A. OLTEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Roxana NEMTEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ilinca-Maria CHIRIAC Sf. Spiridon” County Clinical Emergency Hospital Iasi
  • Oana TIMOFTE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • G.G. BALAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Catalina MIHAI “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Gabriela STEFANESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Lilia LICA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Cristiana ANDRONIC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Irina CIORTESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
Keywords: METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD), SEROLOGICAL MARKERS, 2D SHEAR WAVE ELASTOGRAPHY

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) previously known as non-alcoholic fatty liver disease (NAFLD), represents nowadays the most common cause of chronic liver disease. The gold-standard method for assessing the degree of steatosis and fibrosis is liver biopsy (invasive method). The aim of the study was to establish the role of non-invasive testing (serological and imagistic) in identifying MASLD patients at higher risk to develop advanced fibrosis. Materials and methods: a total of 111 patients with MASLD was tested for fibrosis using non-invasive tests. Serological test that were used consisted in the NAFLD fibrosis score (NFS), Fibrosis Index for liver fibrosis (FIB-4) and BARD. Imagistic method consisted in 2D shear wave elastography (2D-SWE.GE elastography). Results: The majority of patients (54.9%) had significant fibrosis (F2-F4). The degree of liver fibrosis assessed by 2D-SWE.GE elastography could have been correlated with a range of serological parameters. Liver transaminase values were, in the majority of subjects, the only changes detected. The increase was moderate, and the ASAT/ALAT ratio was subunit. We found statistically significant differences between subgroups of patients with and without advanced fibrosis in the following parameters: BMI, platelets, albumin, blood glucose. All three types of testing identified the cases with significant fibrosis. NFS testing correlated best with advanced fibrosis estimated from 2D-SWE.GE elastometry. Conclusions: Serological and imagistic tests are validated tools to predict advanced fibrosis in MASLD patients. The limitation of the study is the relatively small number of patients and the lack of reporting on liver biopsy.

Author Biographies

V.A. OLTEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Roxana NEMTEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Ilinca-Maria CHIRIAC, Sf. Spiridon” County Clinical Emergency Hospital Iasi

Department of Cardiology

Oana TIMOFTE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

G.G. BALAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Catalina MIHAI, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Gabriela STEFANESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Lilia LICA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Cristiana ANDRONIC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

Irina CIORTESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
“Sf. Spiridon” County Clinical Emergency Hospital Iasi,
Institute of Gastroenterology and Hepatology

References

1. Chan WK, Chuah KH, Rajaram RB, Lim LL, Ratnasingam J, Vethakkan SR. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. J Obes Metab Syndr 2023; 32(3): 197-213.
2. Bae, Sarah Da Won, Jacob George and Liang Qiao. From MAFLD to hepatocelluar carcinoma and everything in between. Chin Med J 135 (2022): 547-556.
3. Younossi, Zobair M., Mary E.Rinella, Arun J. Sanyal and Stephen A. Harrison, et al. From NAFLD to MAFLD: implications of a premature change in terminology. Hepatol 73(2021):1194-1198.
4. Pinyol, Roser, Sara Torrecilla, Huan Wang and Carla Montironi et al. Corrigendum to molecular characterisation of hepatocellular carcinoma in patients with non-alcholic steatohepatitis. J Hepatol 75 (2021):1515.
5. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new defini-tion for metabolic dysfunction associated fatty liver disease: An international expert consensus state-ment. J Hepatol 2020; 73: 202-209.
6. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identi-fies liver fibrosis in patients with NAFLD. Hepatology 2007; 45(4): 846-854.
7. Cichoż-Lach H, Celiński K, Prozorow-Król B, et al. The BARD score and the NAFLD fibrosis score in the assessment of advanced liver fibrosis in nonalcoholic fatty liver disease. Med Sci Monit 2012; 18(12): 735-740.
8. Harrison SA, Oliver D, Arnold HL, Gogia S, Neuschwander-Tetri BA. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut 2008; 57(10): 1441-1447.
9. Kim DW, Suh CH, Kim KW, et al. Technical Performance of Two-Dimensional Shear Wave Elas-tography for Measuring Liver Stiffness: A Systematic Review and Meta-Analysis. Korean J Radiol 2019; 20(6): 880-893.
10. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30(6): 1356-1362.
11. Mofrad P, Contos MJ, Haque M, et al. Clinical and histological spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology 2003: 37: 1286-1292.
12. Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008; 134(4): 960-974.
13. Martínez SM, Crespo G, Navasa M, Forns X. Noninvasive assessment of liver fibrosis. Hepatology 2011; 53(1): 325-335.
14. Fitzpatrick E, Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future. World J Gastroenterol 2014; 20(31): 10851-10863.
15. Patel K, Shackel NA. Current status of fibrosis markers. Curr Opin Gastroenterol 2014; 30: 253-259.
16. Tsai E, Lee TP. Diagnosis and Evaluation of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steato-hepatitis, Including Noninvasive Biomarkers and Transient Elastography. Clin Liver Dis 2018; 22(1): 73-92.
17. Castera L. Noninvasive Evaluation of Nonalcoholic Fatty Liver Disease. Semin Liver Dis 2015; 35(3): 291-303.
18. Ciećko-Michalska I, Szczepanek M, Wierzbicka-Tutka I, Zahradnik-Bilska J, Mach T. Non-invasive diagnosis of steatosis, inflammatory changes and liver fibrosis in patients with non-alcoholic fatty liver diseases. Pilot study. Arch Med Sci Atheroscler Dis 2018; 28(3): 179-183.
19. Sun W, Cui H, Li N, et al. Comparison of FIB-4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non-alcoholic fatty liver disease: A meta-analysis study. Hepatol Res 2016; 46(9): 862-970.
20. Patel P, Hossain F, Horsfall LU, et al. A pragmatic approach identifies a high rate of nonalcoholic fatty liver disease with advanced fibrosis in diabetes clinics and at-risk populations in primary care. Hepatol Commun 2018; 2: 893-905.
21. McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut 2010; 59(9): 1265-1269.
22. Castera L, Chan HLY, Arrese M. For the Clinical Practice Guideline Panel. EASL-ALEH clinical practice guidelines: noninvasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63: 237-264.
23. Ciećko-Michalska I, Szczepanek M, Wierzbicka-Tutka I, Zahradnik-Bilska J, Mach T. Non-invasive diagnosis of steatosis, inflammatory changes and liver fibrosis in patients with non-alcoholic fatty liver diseases. Pilot study. Arch Med Sci Atheroscler Dis 2018; 28(3): 179-183.
Published
2024-03-29
Section
INTERNAL MEDICINE - PEDIATRICS