Zijlstra Michael K, Gampa Anuhya, Joseph Nora, Sonnenberg Amnon, Fimmel Claus J
Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States.
Division of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States.
World J Hepatol. 2023 Feb 27;15(2):225-236. doi: 10.4254/wjh.v15.i2.225.
Cirrhosis and its complications develop in a subgroup of patients with non-alcoholic fatty liver disease (NASH). Early detection of liver fibrosis represents an important goal of clinical care.
To test the hypothesis that the development of cirrhosis in nonalcoholic fatty liver disease patients is preceded by the long-term trends of platelet counts and Fib-4 scores.
We identified all patients in our healthcare system who had undergone fibrosis staging by liver biopsy or magnetic resonance elastography (MRE) for non-alcoholic fatty liver disease during the past decade ( = 310). Platelet counts, serum glutamic-pyruvic transaminase and serum glutamic oxalacetic transaminase values preceding the staging tests were extracted from the electronic medical record system, and Fib-4 scores were calculated. Potential predictors of advanced fibrosis were evaluated using multivariate regression analysis.
Significant decreases in platelet counts and increases in Fib-4 scores were observed in all fibrosis stages, particularly in patients with cirrhosis. In the liver biopsy group, the presence of cirrhosis was best predicted by the combination of the Fib-4 score at the time closest to staging ( < 0.0001), the presence of diabetes ( = 0.0001), and the correlation coefficient of the preceding time-dependent drop in platelet count ( = 0.044). In the MRE group, Fib4 score ( = 0.0025) and platelet drop ( = 0.0373) were significant predictors. In comparison, the time-dependent rise of the Fib-4 score did not contribute in a statistically significant way.
Time-dependent changes in platelet counts and Fib-4 scores contribute to the prediction of cirrhosis in NASH patients with biopsy- or MRE-staged fibrosis. Their incorporation into predictive algorithms may assist in the earlier identification of high-risk patients.
肝硬化及其并发症在非酒精性脂肪性肝病（NASH）患者的一个亚组中发生。肝纤维化的早期检测是临床护理的一个重要目标。
检验非酒精性脂肪性肝病患者发生肝硬化之前血小板计数和Fib-4评分存在长期变化趋势这一假设。
我们确定了在过去十年中在我们的医疗系统中因非酒精性脂肪性肝病接受肝活检或磁共振弹性成像（MRE）进行纤维化分期的所有患者（n = 310）。从电子病历系统中提取分期检查之前的血小板计数、血清谷丙转氨酶和血清谷草转氨酶值，并计算Fib-4评分。使用多变量回归分析评估晚期纤维化的潜在预测因素。
在所有纤维化阶段均观察到血小板计数显著下降和Fib-4评分升高，尤其是在肝硬化患者中。在肝活检组中，最能预测肝硬化存在的因素是最接近分期时的Fib-4评分（P < 0.0001）、糖尿病的存在（P = 0.0001）以及之前血小板计数随时间下降的相关系数（P = 0.044）。在MRE组中，Fib4评分（P = 0.0025）和血小板下降（P = 0.0373）是显著的预测因素。相比之下，Fib-4评分随时间的升高在统计学上没有显著贡献。
血小板计数和Fib-4评分随时间的变化有助于预测经活检或MRE分期纤维化的NASH患者的肝硬化。将它们纳入预测算法可能有助于更早识别高危患者。
