Evaluation of Noninvasive Methods for Preoperative Diagnosis of Advanced Liver Fibrosis or Hepatic Cirrhosis in Morbid Obesity

Abstract

Introduction Currently obesity is an epidemic in Western society, with significant increase in prevalence. There are several comorbidities such as systemic hypertension, insulin resistance, dyslipidemia and NAFLD/NASH (Nonalcoholic Fatty Liver Diasease/Non alcoholic steatohepatitis). The liver biopsy is the gold standard for diagnosis of this condition. Due to several difficulties with this method, we compare some non-invasive markers for identification of severe/advanced fibrosis and cirrhosis. Materials & Methods We studied 638 patients undergoing bariatric surgery. Among them, 83 patients underwent liver biopsy. The laboratory data were obtained from medical records, and calculated the following markers: AAR, AP index, APRI, CDS and HALT-C. Using biopsies, performed in part of the serie (n=084), as a control group, statistical analysis was performed to identify the best method and cutoff values. Results The more accurate method was APRI, with a cutoff value of 0.6 (sensitivity and specificity, CI, PPV and NPV were calculated). In the group of patients who underwent biopsy, 5 had advanced fibrosis or cirrhosis (6.02 %) and 25 some degree of fibrosis (30.12 %). Discussion In the population studied, the percentages of fibrosis/cirrhosis, and some degree of NAFLD are compatible with literature data. The APRI index would be useful as a predictor in all cases of advanced fibrosis/cirrhosis in this serie. Conclusion Regarding the markers studied, the APRI was the best method to predict advanced liver disease. Thus, it can apparently be used as a screening method for performing liver biopsies.