Use of noninvasive scores for advanced liver fibrosis can guide the need for hepatic biopsy during bariatric procedures.
Surg Obes Relat Dis
; 17(2): 292-298, 2021 Feb.
Article
em En
| MEDLINE
| ID: mdl-33153965
ABSTRACT
BACKGROUND:
Patients with obesity are at increased risk for nonalcoholic fatty liver disease (NAFLD). The effectiveness of noninvasive screening tests for ruling out advanced fibrosis (stage 3-4) is unknown.OBJECTIVES:
To determine the prevalence of advanced fibrosis in patients undergoing routine liver biopsy during bariatric surgery and assess the effectiveness of existing noninvasive risk calculators.SETTING:
Academic medical center in the United States.METHODS:
Routine liver biopsies were obtained during first-time bariatric surgery (January 2001-December 2017). Patient demographic characteristics, co-morbidities, and preoperative laboratory values were compiled. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were compared between 3 noninvasive risk calculators for advanced fibrosis the fibrosis-4 index, NAFLD fibrosis score, and aminotransferase-to-platelet ratio index (APRI).RESULTS:
Among 2465 patients, the prevalence of advanced fibrosis (stage 3-4) was 3.4%. The mean age was 45.5 years, and the mean body mass index was 46.8. The sensitivity of noninvasive risk calculators ranged from 85% (NAFLD fibrosis score) to 24% (APRI). The NAFLD fibrosis score performed best in screening out advanced fibrosis, with an NPV of 99%. The PPV ranged from 9% to 65%. In this study cohort, the use of the NALFD fibrosis score correctly ruled out advanced fibrosis in 893 (36%) patients, with 13 false negatives.CONCLUSIONS:
The prevalence of advanced fibrosis in individuals undergoing routine first-time bariatric procedures is 3.4%. Use of the NALFD fibrosis score can rule out advanced fibrosis in one-third of this population, and guide surgical decision-making.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cirurgia Bariátrica
/
Hepatopatia Gordurosa não Alcoólica
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Humans
/
Middle aged
Idioma:
En
Revista:
Surg Obes Relat Dis
Assunto da revista:
METABOLISMO
Ano de publicação:
2021
Tipo de documento:
Article