Visual Liver Score to Stratify Non-Alcoholic Steatohepatitis Risk and Determine Selective Intraoperative Liver Biopsy in Obesity

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Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), are endemic in obesity. We aimed to evaluate the diagnostic accuracy and reproducibility of a simple intraoperative visual liver score to stratify the risk of NASH and NAFLD in obesity and determine the need for liver biopsy. Methods: This is a prospective cohort study of obese adults undergoing bariatric surgery. The surgical team used a visual liver score to evaluate liver colour, size and surface. This was compared to histology from an intraoperative liver biopsy. Results: There were 152 participants, age 44.6 ± 12 years, BMI 45 ± 8.3 kg/m2. Prevalence of NAFLD was 70.4%, with 12.1% NASH and 26.4% borderline NASH. Single-visual components were less accurate than total composite score. Steatosis was most accurately identified (significant steatosis: AUROC 0.746, p < 0.05; severe steatosis: AUROC 0.855, p < 0.05). NASH was identified with moderate accuracy (AUROC 0.746, p = 0.001), with sensitivity 75% for a score ≥ 2. Stratification into low (≤ 1) and high-risk (≥ 4) scores accurately identified patients who should or should not have an intraoperative biopsy. Most patients with a normal-appearing liver did not have disease (94.4%). The structured visual assessment was quick and interobserver agreement was reasonable (κ = 0.53, p < 0.05). Conclusions: A simple, structured tool based on liver appearance can be a useful and reliable tool for NAFLD risk stratification and identification of patients who would most and least benefit from a biopsy. A normal liver appearance reliably excludes significant liver disease, avoiding the need for liver biopsy in patients otherwise at high clinical risk of NASH.

Original languageEnglish
Pages (from-to)427-436
Number of pages10
JournalObesity Surgery
Volume28
Issue number2
DOIs
Publication statusPublished - Feb 2018

Keywords

  • Intraoperative liver biopsy
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Obesity
  • Visual appearance

Cite this

@article{c72034095de44efbbb4b646ce368a71a,
title = "Visual Liver Score to Stratify Non-Alcoholic Steatohepatitis Risk and Determine Selective Intraoperative Liver Biopsy in Obesity",
abstract = "Background: Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), are endemic in obesity. We aimed to evaluate the diagnostic accuracy and reproducibility of a simple intraoperative visual liver score to stratify the risk of NASH and NAFLD in obesity and determine the need for liver biopsy. Methods: This is a prospective cohort study of obese adults undergoing bariatric surgery. The surgical team used a visual liver score to evaluate liver colour, size and surface. This was compared to histology from an intraoperative liver biopsy. Results: There were 152 participants, age 44.6 ± 12 years, BMI 45 ± 8.3 kg/m2. Prevalence of NAFLD was 70.4{\%}, with 12.1{\%} NASH and 26.4{\%} borderline NASH. Single-visual components were less accurate than total composite score. Steatosis was most accurately identified (significant steatosis: AUROC 0.746, p < 0.05; severe steatosis: AUROC 0.855, p < 0.05). NASH was identified with moderate accuracy (AUROC 0.746, p = 0.001), with sensitivity 75{\%} for a score ≥ 2. Stratification into low (≤ 1) and high-risk (≥ 4) scores accurately identified patients who should or should not have an intraoperative biopsy. Most patients with a normal-appearing liver did not have disease (94.4{\%}). The structured visual assessment was quick and interobserver agreement was reasonable (κ = 0.53, p < 0.05). Conclusions: A simple, structured tool based on liver appearance can be a useful and reliable tool for NAFLD risk stratification and identification of patients who would most and least benefit from a biopsy. A normal liver appearance reliably excludes significant liver disease, avoiding the need for liver biopsy in patients otherwise at high clinical risk of NASH.",
keywords = "Intraoperative liver biopsy, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Obesity, Visual appearance",
author = "Ooi, {Geraldine J.} and Burton, {Paul R.} and Arul Earnest and Cheryl Laurie and Kemp, {William W.} and Nottle, {Peter D.} and McLean, {Catriona A.} and Roberts, {Stuart K.} and Brown, {Wendy A.}",
year = "2018",
month = "2",
doi = "10.1007/s11695-017-2859-3",
language = "English",
volume = "28",
pages = "427--436",
journal = "Obesity Surgery",
issn = "0960-8923",
publisher = "Springer-Verlag London Ltd.",
number = "2",

}

TY - JOUR

T1 - Visual Liver Score to Stratify Non-Alcoholic Steatohepatitis Risk and Determine Selective Intraoperative Liver Biopsy in Obesity

AU - Ooi, Geraldine J.

AU - Burton, Paul R.

AU - Earnest, Arul

AU - Laurie, Cheryl

AU - Kemp, William W.

AU - Nottle, Peter D.

AU - McLean, Catriona A.

AU - Roberts, Stuart K.

AU - Brown, Wendy A.

PY - 2018/2

Y1 - 2018/2

N2 - Background: Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), are endemic in obesity. We aimed to evaluate the diagnostic accuracy and reproducibility of a simple intraoperative visual liver score to stratify the risk of NASH and NAFLD in obesity and determine the need for liver biopsy. Methods: This is a prospective cohort study of obese adults undergoing bariatric surgery. The surgical team used a visual liver score to evaluate liver colour, size and surface. This was compared to histology from an intraoperative liver biopsy. Results: There were 152 participants, age 44.6 ± 12 years, BMI 45 ± 8.3 kg/m2. Prevalence of NAFLD was 70.4%, with 12.1% NASH and 26.4% borderline NASH. Single-visual components were less accurate than total composite score. Steatosis was most accurately identified (significant steatosis: AUROC 0.746, p < 0.05; severe steatosis: AUROC 0.855, p < 0.05). NASH was identified with moderate accuracy (AUROC 0.746, p = 0.001), with sensitivity 75% for a score ≥ 2. Stratification into low (≤ 1) and high-risk (≥ 4) scores accurately identified patients who should or should not have an intraoperative biopsy. Most patients with a normal-appearing liver did not have disease (94.4%). The structured visual assessment was quick and interobserver agreement was reasonable (κ = 0.53, p < 0.05). Conclusions: A simple, structured tool based on liver appearance can be a useful and reliable tool for NAFLD risk stratification and identification of patients who would most and least benefit from a biopsy. A normal liver appearance reliably excludes significant liver disease, avoiding the need for liver biopsy in patients otherwise at high clinical risk of NASH.

AB - Background: Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), are endemic in obesity. We aimed to evaluate the diagnostic accuracy and reproducibility of a simple intraoperative visual liver score to stratify the risk of NASH and NAFLD in obesity and determine the need for liver biopsy. Methods: This is a prospective cohort study of obese adults undergoing bariatric surgery. The surgical team used a visual liver score to evaluate liver colour, size and surface. This was compared to histology from an intraoperative liver biopsy. Results: There were 152 participants, age 44.6 ± 12 years, BMI 45 ± 8.3 kg/m2. Prevalence of NAFLD was 70.4%, with 12.1% NASH and 26.4% borderline NASH. Single-visual components were less accurate than total composite score. Steatosis was most accurately identified (significant steatosis: AUROC 0.746, p < 0.05; severe steatosis: AUROC 0.855, p < 0.05). NASH was identified with moderate accuracy (AUROC 0.746, p = 0.001), with sensitivity 75% for a score ≥ 2. Stratification into low (≤ 1) and high-risk (≥ 4) scores accurately identified patients who should or should not have an intraoperative biopsy. Most patients with a normal-appearing liver did not have disease (94.4%). The structured visual assessment was quick and interobserver agreement was reasonable (κ = 0.53, p < 0.05). Conclusions: A simple, structured tool based on liver appearance can be a useful and reliable tool for NAFLD risk stratification and identification of patients who would most and least benefit from a biopsy. A normal liver appearance reliably excludes significant liver disease, avoiding the need for liver biopsy in patients otherwise at high clinical risk of NASH.

KW - Intraoperative liver biopsy

KW - Non-alcoholic fatty liver disease

KW - Non-alcoholic steatohepatitis

KW - Obesity

KW - Visual appearance

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U2 - 10.1007/s11695-017-2859-3

DO - 10.1007/s11695-017-2859-3

M3 - Article

VL - 28

SP - 427

EP - 436

JO - Obesity Surgery

JF - Obesity Surgery

SN - 0960-8923

IS - 2

ER -