Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 9/2021

01-09-2021 | Obesity | Original Article

Predictive scoring system for advanced liver fibrosis in Japanese patients with severe obesity

Authors: Haruka Nikai, Akira Sasaki, Akira Umemura, Naoto Takahashi, Hiroyuki Nitta, Risaburo Akasaka, Keisuke Kakisaka, Hidekatsu Kuroda, Kazuyuki Ishida, Yasuhiro Takikawa

Published in: Surgery Today | Issue 9/2021

Login to get access

Abstract

Purpose

The aim of this study was to examine the predictive scoring system of advanced liver fibrosis in severely obese Japanese patients.

Methods

Seventy-two patients underwent laparoscopic sleeve gastrectomy and intraoperative liver biopsies. We classified these patients into two groups: Brunt stage ≥ 2 (advanced fibrosis) and 0/1 (none/mild fibrosis). A logistic regression analysis was performed to identify the predictors of advanced fibrosis.

Results

Sixteen patients had advanced fibrosis, while 56 had no/mild fibrosis. The prevalence of type 2 diabetes mellitus (T2DM) in advanced fibrosis group was significantly higher than in none/mild fibrosis. An univariate analysis of the factors predicting advanced fibrosis showed significant differences in AST/ALT ratio, serum insulin levels, HOMA-IR, and type IV collagen 7S in the T2DM group. According to a multivariate analysis, type IV collagen 7S was an independent predictor and the cutoff value was 5.6 ng/mL. We created a flow chart; high risk (T2DM and type IV collagen 7S ≥ 5.6 ng/mL), moderate risk (T2DM and type IV collagen 7S < 5.6 ng/mL), and low risk (non-DM). For those at high risk, the sensitivity, specificity, positive predictive value, and negative predictive value were 56.2%, 94.4%, 75.0%, and 87.9%, respectively.

Conclusion

This classification system has the potential to accurately categorize the risk of liver fibrosis.
Literature
1.
Sakugawa H, Nakayoshi T, Kobashigawa K, Yamashiro T, Maeshiro T, Miyagi S, et al. Clinical usefulness of biochemical markers of liver fibrosis in patients with nonalcoholic fatty liver disease. World J Gastroenterol. 2005;11:255–9.CrossRef
2.
Eguchi Y, Hyogo H, Ono M, Mizuta T, Ono N, Fujimoto K, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol. 2012;47:586–95.CrossRef
3.
Cummings DE, Cohen RV. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. Lancet Diabetes Endocrinol. 2014;2:175–81.CrossRef
4.
Ohta M, Seki Y, Wong SK, Wang C, Huang C, Aly A, et al. Bariatric/metabolic surgery in the Asia-Pacific region: APMBSS survey. Obes Surg. 2018;29:534–41.CrossRef
5.
Bower G, Toma T, Harling L, Jiao LR, Efthimiou E, Darzi A, et al. Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg. 2015;25:2280–9.CrossRef
6.
Lassailly G, Caiazzo R, Buob D, Pigeyre M, Verkindt H, Labreuche J, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology. 2015;149:379–88.CrossRef
7.
Sasaki A, Nitta H, Otsuka K, Umemura A, Baba S, Obuchi T, et al. Bariatric surgery and non-alcoholic fatty liver disease: current and potential future treatments. Front Endoscorinol (Lausanne). 2014;5:164.
8.
Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557–65.CrossRef
9.
Loomba R. The hierarchical model of NAFLD: prognostic significance of histologic features in NASH. Gastroenterology. 2015;149:278–80.CrossRef
10.
Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatrol. 2009;7:1004–112.
11.
Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.CrossRef
12.
Kao WY, Chang IW, Chen CL, Su CW, Fang SU, Tang JH, et al. Fibroscan-based score to predict significant liver fibrosis in mobidly obese patients with nonalcoholic fatty liver disease. Obes Surg. 2020;30(4):1249–57.CrossRef
13.
Okanoue T, Ebise H, Kai T, Mizuno M, Shima T, Ichihara J, et al. A simple scoring system using type IV collagen 7S and aspartate aminotransferase for diagnosing nonalcoholic steatohepatitis and related fibrosis. J Gastroenterol. 2018;53:129–39.CrossRef
14.
Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.CrossRef
15.
Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Teri BA, Bacon BR, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–74.CrossRef
16.
Sakamoto M, Tsujikawa H, Effendi K, Ojima H, Harada K, Zen Y, et al. Pathological findings of nonalcoholic steatohepatitis and nonalcoholic fatty liver disease. Pathol Int. 2017;67:1–7.CrossRef
17.
Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, et al. Liver fibrosis in overweight patients. Gastroenterology. 1999;118:1117–23.CrossRef
18.
Seki Y, Kakizaki S, Horiguchi N, Hashizume H, Tojima H, Yamazaki Y, et al. Prevalence of nonalcoholic steatohepatitis in Japanese patients with morbid obesity undergoing bariatric surgery. J Gastroenterol. 2016;51:281–9.CrossRef
19.
Park SH, Kim PN, Kim KW, Lee SW, Yoon SE, Park SW, et al. Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology. 2006;239:105–12.CrossRef
20.
Rogier J, Roullet S, Cornelis F, Biais M, Quinart A, Revel P, et al. Noninvasive assessment of macrovesicular liver steatosis in cadaveric donors based on computed tomography liver-to-spleen attenuation ratio. Liver Transpl. 2015;21:690–5.CrossRef
21.
Endo Y, Ohta M, Tada K, Nakanuma H, Saga K, Masuda T, et al. Improvement of non-alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients. Ann Gastroenterol Surg. 2019;3:285–90.CrossRef
22.
Nikai H, Ishida K, Umemura A, Baba S, Nitta H, Sugai T, et al. Effects of laparoscopic sleeve gastrectomy on non-alcoholic steatohepatitis and liver fibrosis in japanese patients with severe obesity. Obes Surg. 2020;30(7):2579–87.CrossRef
23.
Harrison SA, Oliver D, Arnold HL, et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57:1441–7.CrossRef
24.
Raszeja-Wyszomirska J, Szymanik B, Ławniczak M, Kajor M, Chwist A, Milkiewicz P, et al. Validation of the BARD scoring system in Polish patients with nonalcoholic fatty liver disease (NAFLD). BMC Gastroenterol. 2010;10:67.CrossRef
25.
Fujii H, Enomoto M, Fukushima W, Tamori A, Sakaguchi H, Kawada N. Applicability of BARD score to Japanese patients with NAFLD. Gut. 2009;58:1566–7.CrossRef
26.
Subichin M, Clanton J, Makuszewski M, Bohon A, Zografakis JG, Dan A. Liver disease in the morbidly obese: a review of 1000 consecutive patients undergoing weight loss surgery. Surg Obes Relat Dis. 2015;11:137–41.CrossRef
27.
Lu FB, Hu ED, Xu LM, Chen L, Wu JL, Li H, et al. The relationship between obesity and the severity of non-alcoholic fatty liver disease: systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2018;12:491–502.CrossRef
28.
Sumida Y, Yoneda M, Hyogo H, Itoh Y, Ono M, Fujii H, et al. Validation of the FIB-4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol. 2012;12:2.CrossRef
29.
Kim M, Jun DW, Park H, Kang BK, Sumida Y. Sequential combination of FIB-4 followed by M2BPGi enhanced diagnostic performance for advanced hepatic fibrosis in an average risk population. J Clin Med. 2020;9:1119.CrossRef
30.
Nakahara T, Hyogo H, Yoeda M, Sumida Y, Eguchi Y, Fujii H, Japan Study Group of Nonalcoholic Fatty Liver Disease, et al. Type 2 diabetes mellitus associated with the fibrosis severity in patients with nonalcoholic fatty liver disease in a large retrospective cohort of Japanese patients. J Gastroenterol. 2014;49:1477–84.CrossRef
31.
Shima T, Seki K, Umemura A, Ogawa R, Horimoto R, Oya H, et al. Influence of lifestyle-related diseases and age on the development and progression of non-alcoholic fatty liver disease. Hepatol Res. 2015;45:548–59.CrossRef
32.
Alexander M, Loomis AK, van der Lei J, Duarte-Salles T, Prieto-Alhambra D, Ansell D, et al. Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts. BMC Med. 2019;17:95.CrossRef
33.
Yoeda M, Mawatari H, Fujita K, Yonemitsu K, Kato S, Takahashi H, et al. Type IV collagen 7s domain is an independent clinical marker of the severity of fibrosis in patients with nonalcoholic steatohepatitis before the cirrhotic stage. J Gastroenterol. 2007;42:375–81.CrossRef
34.
Mizuno M, Shima T, Oya H, Mitsumoto Y, Mizuno C, Isoda S, et al. Classification of patients with non-alcoholic fatty liver disease using rapid immunoassay of serum type IV collagen compared with liver histology and other fibrosis markers. Hepatol Res. 2016;47:216–25.CrossRef
35.
Brandon H, Martin W. Protein homeostasis: live long, won’t prosper. Nat Rev Mol Cell Biol. 2013;14:55–61.CrossRef
Metadata
Title
Predictive scoring system for advanced liver fibrosis in Japanese patients with severe obesity
Authors
Haruka Nikai
Akira Sasaki
Akira Umemura
Naoto Takahashi
Hiroyuki Nitta
Risaburo Akasaka
Keisuke Kakisaka
Hidekatsu Kuroda
Kazuyuki Ishida
Yasuhiro Takikawa
Publication date
01-09-2021
Publisher
Springer Singapore
Published in
Surgery Today / Issue 9/2021
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-021-02266-w

Other articles of this Issue 9/2021

Surgery Today 9/2021 Go to the issue

Original Article

Clinical significance of surgical intervention for imatinib-resistant gastrointestinal stromal tumors in the era of multiple tyrosine kinase inhibitors

Original Article

Optimal treatment and complications of patients with the perforated upper gastrointestinal tract

Original Article

Clinical outcome of cardiac surgery in patients with remitted or active hepatocellular carcinoma

Original Article

The prevalence and risk factors associated with preoperative deep venous thrombosis in lung cancer surgery

Short Communication

Validation of the Simplified Inguinal Pain Questionnaire for assessing postoperative pain and disability following hernioplasty

Original Article

Prediction of the tumor response and survival based on computed tomography in esophageal squamous cell carcinoma after trimodality therapy