Accuracy of Non-invasive Indices for Diagnosing Hepatic Steatosis Compared to Imaging in a Real-World Cohort.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease is common and under-diagnosed. This study evaluated the accuracy of several previously reported indices, including hepatic steatosis index, alanine aminotransferase (ALT) method, Framingham steatosis index, and Dallas steatosis index, to diagnose hepatic steatosis in a real-world cohort. METHODS: This study included 701 randomly selected adult patients seen in our integrated healthcare system between 2015 and 2020 with appropriate abdominal imaging and routine outpatient laboratory studies. Information on demographics, comorbidities and existing liver disease, anthropometrics, laboratory studies, and abdominal imaging was collected. The sensitivity, specificity, and C-statistic of each method in detecting hepatic steatosis based on abdominal imaging were determined. RESULTS: 202/701 patients (28.8%) had hepatic steatosis on abdominal imaging. These patients were more likely to have metabolic syndrome components and higher body mass index. All indices performed similarly with moderate accuracy in detecting hepatic steatosis based on the C-statistic (95% confidence interval): Hepatic steatosis index 0.76 (0.72-0.79), Framingham steatosis index 0.78 (0.74-0.82), and Dallas steatosis index 0.80 (0.76-0.83). ALT method had sensitivity 44.7% (36.9-52.7%) and specificity 88.6% (85.0-91.7%). Several sensitivity analyses were performed, which did not significantly alter the performance of any index. CONCLUSION: The findings support both the clinical utility of these indices in diagnosing hepatic steatosis in the absence of imaging in real-world settings and the research utility of these indices in generating reliable electronic medical record-based nonalcoholic fatty liver disease cohorts.

The Utility of Routinely Obtaining Postoperative Laboratory Studies Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion.

STUDY DESIGN: This is a retrospective analysis. OBJECTIVE: To test the hypothesis that there is limited utility in routinely obtaining postoperative laboratory values following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). BACKGROUND DATA: At many institutions, it is routine to obtain a complete blood count and basic metabolic profile (BMP) following a MIS TLIF. However, the utility of this practice has not been well characterized. METHODS: A total of 332 consecutive patients who underwent a primary, 1-level MIS TLIF for degenerative spinal pathology between 2007 and 2013 were identified. Patients were stratified into low-risk and high-risk cohorts based upon risk for postoperative laboratory abnormalities. Inclusion criteria for the high-risk cohort were malignancy, complicated diabetes, renal failure, liver disease, hematologic disease, or significant intraoperative blood loss (>300 mL). Preoperative and postoperative hemoglobin (Hb), hematocrit, and BMP values were compared. Any interventions that were potentially related to laboratory values were identified. RESULTS: Totals of 270 low-risk and 62 high-risk patients were identified. Mean postoperative Hb, hematocrit, blood urea nitrogen, sodium, potassium, and calcium values were decreased compared with preoperative values (P<0.001 for each) in both cohorts. Similar changes from preoperative levels were demonstrated in each cohort. No patients received blood product transfusion. Eleven low-risk (4.1%) and 5 high-risk patients (8.1%) received oral potassium supplementation. All patients who received potassium supplementation were asymptomatic. Most patients who were given potassium replacement consumed medications known to decrease serum potassium levels. No other interventions were performed in either group. CONCLUSIONS: Despite a significant decrease in mean Hb concentration following surgery, no patients required a transfusion. In total, 16 patients received potassium supplementation likely related to medication-related potassium deficits. Overall, these findings suggest that the utility of routinely obtaining a complete blood count or BMP following uncomplicated MIS TLIF may be limited except in the setting of select preoperative comorbidities and/or perioperative risk factors or events. LEVEL OF EVIDENCE: Level III.