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Abstract Details
Biopsy Rate and Nonalcoholic Steatohepatitis (NASH) in Patients With Nonalcoholic Fatty Liver Disease (NAFLD)
Scand J Gastroenterol. 2020 Jun 1;1-6. doi: 10.1080/00365521.2020.1766554.Online ahead of print.
Florian Gerhardt1, David Petroff2, Valentin Blank13, Albrecht Böhlig1, Florian van Bömmel1, Christian Wittekind4, Thomas Berg1, Thomas Karlas1, Johannes Wiegand1
Author information
1Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany.
2Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany.
3Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany.
4Institute of Pathology, University Hospital Leipzig, Leipzig, Germany.
Abstract
Background: Licensed therapies for nonalcoholic fatty liver disease (NAFLD) do not yet exist, but clinical trials are testing treatment options. Inclusion criteria often require liver biopsy showing fibrosis (F2/3) or cirrhosis (F4) and nonalcoholic steatohepatitis (NASH). However, histological criteria pose a serious obstacle for recruitment.Aims: Characterize the relevance of liver biopsies in the selection of patients with NAFLD.Methods: Patients between 2013 and 2018 with the ICD-10 code K76.0 were analyzed. Fibrosis was defined by the NASH clinical research network (CRN) fibrosis staging system, NASH by a NAFLD activity score (NAS) ≥4. Predictive factors were determined by logistic regression.Results: Liver biopsy was performed in 87/638 (13.6%) patients (49% female, age 52.5 ± 14.0, BMI 30.4 ± 5.9 kg/m2). Fibrosis stage F0/F1/F2/F3/F4 was observed in N = 7/47/7/17/9, an NAS ≥4 in N = 27. Fibrosis stage F2/F3 and F4 along with NAS ≥4 was found in 1.7% and 0.5% of cases. Liver stiffness measurement, LSM (OR 2.3 per doubling of value; CI 1.3-4.4, p = .005) and FIB-4 (OR 2.3 per doubling of value; CI 1.2-4.4, p = .012) were significant predictors for fibrosis ≥ F2. Predictive factors for NASH were not identified.Conclusion: The biopsy rate in NAFLD patients is low and fibrosis ≥ F2 along with NAS ≥4 only present in a few cases. Transient elastography and FIB-4 are useful to select patients at risk for fibrosis for liver biopsy.