Published in:
01-12-2010 | Clinical Research
Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Utility of FIBROspect II to Detect Liver Fibrosis in Morbidly Obese Hispano-American Patients Undergoing Gastric Bypass
Published in: Obesity Surgery | Issue 12/2010
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Background
Our study describes the prevalence of nonalcoholic steatohepatitis (NASH) and liver fibrosis in Hispano-American morbidly obese patients and the utility of different serum markers to predict significant liver fibrosis in this population.
Methods
We perform a retrospective chart review of all patients undergoing Roux-en-Y gastric bypass with routine liver biopsy performed at Valley Baptist medical center during a 24-month period (2005–2006).
Results
Of 129 liver biopsies, only 25.7% had some degree of steatosis, but about 55% had NASH, and 30.9% had liver fibrosis. Of those patients with liver fibrosis, only 6.9% had moderate to severe fibrosis (stages 2–4), and only one patient had cirrhosis (0.7%). Of the 129 patients, only 92 had a FIBROspect score II in their chart, and they ranged from 9 to 95, with a mean of 28.3. Of these patients, 36 had a score less than 20, and none had significant fibrosis in their biopsy. FIBROspect II® score (cutoff <20) had a negative predictive value (NPV) of 100% (confidence interval (CI) 95%, 0.9035–1) positive predictive value (PPV) of 15% (CI 95%, 0.0838–0.2693), sensitivity of 100%, and specificity of 42% to predict stage 2 fibrosis or higher.
Conclusions
NASH and liver fibrosis are present in a high percentage of morbidly obese patients. Liver function tests and ultrasound are not reliable tests to diagnose or rule out advance liver fibrosis. The use of FIBROspect II® score in the preoperative evaluation of morbidly obese patients can rule out significant liver fibrosis (stages 2–4) and avoid the morbidities related to liver biopsy.