Use of noninvasive markers to predict advanced fibrosis/cirrhosis in severe obesity

Autor(es)

de Cleva, Roberto ^[1] ; Duarte, Livio Fiolo ^[1] ; Furst Crenitte, Milton Roberto ^[1] ; Marques de Oliveira, Claudia Pinto ^[1] ; Pajecki, Denis ^[1] ; Santo, Marco Aurelio ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Dept Gastroenterol, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Surgery for Obesity and Related Diseases; v. 12, n. 4, p. 862-867, MAY 2016.
• Citações Web of Science: 1

Resumo

Background: Nonalcoholic steatohepatitis is observed in 25%-55% of patients with severe obesity and in 2%-12% with bridging fibrosis or cirrhosis. There is currently no noninvasive test for the diagnosis of severe liver fibrosis before bariatric surgery. Objectives: To determine the best noninvasive test for predicting advanced liver disease in patients with severe obesity. Setting: University tertiary care hospital, Brazil. Methods: A cross-sectional retrospective study was conducted with 699 patients with severe obesity undergoing bariatric surgery: 568 without a biopsy (nonbiopsy cohort) and 131 patients who had undergone an intraoperative liver biopsy. The tissues were subjected to histologic diagnosis (Brunt criteria) and classified as advanced fibrosis (stages 3 and 4) or no significant fibrosis (absence of nonalcoholic steatohepatitis and stages 1 or 2). The following predictive indices of cirrhosis were calculated in all patients: aspartate aminotransferase/alanine aminotransferase ratio (AAR), age platelet (AP) index, aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), and hepatitis C antiviral long-term treatment against cirrhosis (HALT-C). The cutoff values, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUROCs) were calculated for patients with biopsies. Results: The AUROC of the AAR, AP, APRI, CDS, and HALT-C model for predicting advanced fibrosis or cirrhosis were, respectively, .522, .88, .99, .905, and .921. The calculated cutoff values, sensitivity, and specificity, respectively, were as follows: AAR: .94, .7, .45; AP 5, .7, .93; APRI .44, 1.0, .97; CDS 6, .7, .97; and HALT-C: .76, 1.0, .77. Conclusion: APRI index was the best predictor of advanced liver disease in patients with severe obesity. (Surg Obes Relat Dis 2016;12:862-867.) (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved. (AU)

• Processo FAPESP: 10/09441-1 - Relação APRI na obesidade mórbida antes e após cirurgia bariátrica
• Beneficiário: Milton Roberto Furst Crenitte
• Modalidade de apoio: Bolsas no Brasil - Iniciação Científica