Changes in indicators of fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on the stage of cirrhosis

Authors

  • N. R. Matkovska Ivano-Frankivsk National Medical University, Ukraine,
  • N. H. Virstiuk Ivano-Frankivsk National Medical University, Ukraine,
  • P. R. Herych Ivano-Frankivsk National Medical University, Ukraine,
  • U. V. Balan Clinical and Diagnostic Laboratory of the Regional Clinical Hospital, Ivano-Frankivsk, Ukraine,
  • Yu. V. Pertsovych Regional Clinical Hospital, Ivano-Frankivsk, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2020.1.203626

Keywords:

alcoholic liver disease, non-alcoholic fatty liver disease, liver cirrhosis

Abstract

 

Objective was to study changes in liver parenchyma fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on decompensation using shear wave elastography and FIB-4 index.

Material and methods. The study included 204 patients. Among them, 78 patients (Group I) had alcoholic liver cirrhosis (ALC) and 126 patients (Group II) had a combination of ALC with non-alcoholic fatty liver disease (NAFLD). Patients were subgrouped according to compensation classes by the Child-Pugh score (A, B, C). The degree of liver parenchyma fibrosis was assessed by calculating the FIB-4 (FibroIndex-4) and the liver parenchyma elasticity (kPa) determined by the shear wave elastography method.

Results. Values of liver parenchyma elasticity in patients of group II of classes A, B, and C were higher compared to group I same classes (P < 0.05). FIB-4 indicators in patients of group II were higher than classes A, B, and C compared to group I (P < 0.05). In patients with ALC in combination with NAFLD, direct correlations were established between the value of Child-Pugh score and the elasticity of the liver parenchyma, the value of the MELD index and the elasticity of the liver parenchyma, the value of Child-Pugh score and FIB-4 index, the value of MELD index and FIB-4 index, FIB-4 index and liver parenchyma elasticity.

Conclusions. In patients with ALC according to elastography and FIB-4 index, fibrosis indicators increase depending on the stage of decompensation. According to elastography and FIB-4 index in patients with ALC, fibrosis indicators were higher in combination with NAFLD at all stages of liver cirrhosis. The magnitude of fibrosis in patients with ALC in combination with NAFLD according to elastography and the FIB-4 index correlates with the severity of liver cirrhosis by Child-Pugh and MELD prognostic index. The combination of shear wave elastography and FIB-4 index are important diagnostic indicators for assessing the degree of fibrosis in the liver.

References

Anstee, Q. M., Targher, G., & Day, C. P. (2013). Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nature Reviews Gastroenterology & Hepatology, 10(6), 330-344. https://doi.org/10.1038/nrgastro.2013.41

Wu, S. Q., Wu, F. Q., Ding, Y. Y., Hou, J., Bi, J. F., & Zhang, Z. (2016). Association of non-alcoholic fatty liver disease with major adverse cardiovascular events: A systematic review and meta-analysis. Scientific Reports, 6. https://doi.org/10.1038/srep33386

Bellentani, S. (2017). The epidemiology of non-alcoholic fatty liver disease. Liver International, 37, 81-84. https://doi.org/10.1111/liv.13299

O'Rourke, J. M., Sagar, V. M., Shah, T., & Shetty, S. (2018). Carcinogenesis on the background of liver fibrosis: Implications for the management of hepatocellular cancer. World Journal of Gastroenterology, 24(39), 4436-4447. https://doi.org/10.3748/wjg.v24.i39.4436

Castera, L. (2018). Diagnosis of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: Non-invasive tests are enough. Liver International, 38, 67-70. https://doi.org/10.1111/liv.13658

Ampuero, J., Pais, R., Aller, R., Gallego-Durán, R., Crespo, J., García-Monzón, C., Boursier, J., Vilar, E., Petta, S., Ming-Hua, Z., Escudero, D., Calleja, J. L., Aspichueta, P., Diago, M., Rosales, J. M., Caballería, J., Gómez-Camarero, J., Iacono, O. L., Benlloch, S., Albillos, A., Turnes, J., Banales, J. M., Ratziu, V., & Romero-Gómez, M. (2019). Development and Validation of Hepamet Fibrosis Scoring System – a Simple, Non-invasive Test to Identify Patients With Nonalcoholic Fatty liver Disease With Advanced Fibrosis. Clinical Gastroenterology and Hepatology, 10, 1-10. https://doi.org/10.1016/j.cgh.2019.05.051

Charlton, M. R., Burns, J. M., Pedersen, R. A., Watt, K. D., Heimbach, J. K., & Dierkhising, R. A. (2011). Frequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States. Gastroenterology, 141(4), 1249-1253. https://doi.org/10.1053/j.gastro.2011.06.061

Hashemi, S. A., Alavian, S. M., & Gholami-Fesharaki, M. (2016). Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Caspian Journal of Internal Medicine, 7(4), 242-252.

Stahl, E. P., Dhindsa, D. S., Lee S. K., Sandesara, P. B., Chalasani, N. P., & Sperling, L. S. (2019). Nonalcoholic Fatty Liver Disease and the Heart JACC State-of-the-Art Review. Journal of the American college of cardiology, 73(8), 948-963. https://doi.org/10.1016/j.jacc.2018.11.050

Sonneveld, M. J., Brouwer, W. P., Chan, H. L-Y., Piratvisuth, T., Jia, J.-D., Zeuzem, S., Liaw, Y.-F., Hansen, B. E., Choi, H., Wat, C., Pavlovic, V., Gaggar, A., Xie, Q., Buti, M., de Knegt, R. J., & Janssen, H. L. A. (2019). Optimisation of the use of APRI and FIB-4 to rule out cirrhosis in patients with chronic hepatitis B: results from the SONIC-B study. Lancet Gastroenterol Hepatol, 4(7), 538-544. doi: 10.1016/S2468-1253(19)30087-1

Potze, W., Siddiqui, M. S., & Sanyal, A. J. (2015). Vascular Disease in Patients with Nonalcoholic Fatty Liver Disease. Seminars in Thrombosis and Hemostasis, 41(5), 488-493. https://doi.org/10.1055/s-0035-1550433

Papadopoulos, N., Vasileiadi, S., Michalea, S., Antonakaki, P., Papavdi, M., Dellaporta, E., Koullias, E., Koutli, E., Manolakopoulos, S., Koskinas, I. G., & Deutsch, M. (2019). The use of APRI and FIB-4 scores versus transient elastography for the assessment of liver fibrosis stage in patients with chronic hepatitis C: Is it possible to reduce the need for elastography? Journal of Hepatology, 70(1), E191-E191. https://doi.org/10.1016/s0618-8278(19)30354-8

Tsai, E., & Lee, T.-P. (2018). Diagnosis and Evaluation of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis, Including Noninvasive Biomarkers and Transient Elastography. Clinics in Liver Disease, 22(1), 73-92. https://doi.org/10.1016/j.cld.2017.08.004

Cantero, I., Elorz, M., Abete, I., Marin, B. A., Herrero, J. I., Monreal, J. I., Benito, A., Quiroga, J., Martínez, A., Huarte, M. P., & Isidro, J. (2019). Ultrasound/Elastography techniques, lipidomic and blood markers compared to Magnetic Resonance Imaging in non-alcoholic fatty liver disease adults. International Journal of Medical Sciences, 16(1), 75-83. https://doi.org/10.7150/ijms.28044

Vilar-Gomez, E., & Chalasani, N. (2018). Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. Journal of Hepatology, 68(2), 305-315. https://doi.org/10.1016/j.jhep.2017.11.013

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1.
Matkovska NR, Virstiuk NH, Herych PR, Balan UV, Pertsovych YV. Changes in indicators of fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on the stage of cirrhosis. Pathologia [Internet]. 2020May25 [cited 2024Apr.24];(1). Available from: http://pat.zsmu.edu.ua/article/view/203626

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Original research