Factors associated with advanced liver fibrosis in patients with non-alcoholic liver disease

Introduction : Non-alcoholic fatty liver disease (NAFLD) is now the leading cause of chronic liver diseases in Western countries. It covers a spectrum of liver problems including benign simple steatosis (fatty liver) and steatohepatitis (NASH) with hepatic injury, inflammation, and fibrosis. Twenty percent of individuals with NASH progress to end-stage liver disease and cirrhosis. The mechanisms determining the progression from fatty liver to steatohepatitis are still unclear. The development and validation of accurate predictors would allow identification of patients at risk for advanced fibrosis, potentially helping monitor disease progression and response to therapeutic modalities.

Aim : To find biomarkers associated with more severe liver fibrosis in a cohort of Polish subjects with biopsy-proven NAFLD.

Results : Sixty consecutive Caucasian patients were enrolled in the study. Predictors of fibrosis F3 and F4 were older age, greater body mass index, higher serum total cholesterol, and increased aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (AAR), as well as characteristics of insulin resistance and lower serum albumin levels. Increased serum levels of type IV collagen and hyaluronic acid were associated with more advanced liver disease. There were trends towards a relationship between advanced fibrosis and female gender, high serum triglycerides, and AST in univariate analysis.

Conclusions: Serum AAR and hyaluronic acid were independent factors associated with more advanced fibrosis in Polish patients with NAFLD in multivariate logistic regression analysis. This population differs from previously described cohorts with fatty liver.