Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery Avaliação do escore de fibrose hepática para doença hepática gordurosa não-alcoólica em pacientes submetidos a cirurgia bariátrica

• Published in: Arquivos de gastroenterologia 2010-06, Vol.47 (2), p.170-173
• Main Authors: Silvania Klug Pimentel, Rodrigo Strobel, Carolina Gomes Gonçalves, Danielle Giacometti Sakamoto, Flávio Heuta Ivano, Júlio Cezar Uili Coelho
• Format: Article
• Language: English
• Subjects: Bariatric surgery; Cirrose hepática; Cirurgia bariátrica; Fatty liver; Fígado gorduroso; Liver cirrhosis; Obesidade mórbida; Obesity, morbid
• ISSN: 0004-2803; 1678-4219
• DOI: 10.1590/S0004-28032010000200010

CONTEXT: Morbidly obese patients have an increased risk for nonalcoholic fat liver disease. Its severe form, nonalcoholic steatohepatitis may cause liver fibrosis. The diagnosis of advanced fibrosis has great value during the pre operative evaluation for bariatric surgery. Currently, liver biopsy is the gold standard for diagnosis of liver fibrosis. OBJECTIVE: To evaluate the nonalcoholic fat liver disease fibrosis score in morbidly obese patients undergoing Roux-en-Y gastric bypass in our population. METHODS: One hundred fifty-eight morbidly obese patients that had undergone bariatric surgery were included. Age, body mass index, hyperglycemia, platelet count, albumin and AST/ALT ratio were applied to the score formula. Scores above 0.676 were indicative of advanced liver fibrosis and scores under -1,455 absence of advanced liver fibrosis. These scores were compared to liver biopsy findings. RESULTS: The presence of advanced fibrosis could be diagnosed with good accuracy, with a positive predictive value of 83.7%. The score had a higher accuracy to exclude advanced fibrosis with a negative predictive value of 97%. Twenty-five patients (16%) had scores between the cutoffs points and were identified as indeterminate. The score sensibility and specificity was 83% and 97% respectively. CONCLUSIONS: The nonalcoholic fat liver disease fibrosis score has high accuracy to identify and exclude advanced liver fibrosis in morbidly obese patients subjected to bariatric surgery.CONTEXTO: Pacientes com obesidade mórbida apresentam risco significativo para doença hepática gordurosa não-alcoólica e para suas formas mais graves, a esteatohepatite e a cirrose hepática. O diagnóstico de tais alterações é importante, principalmente na avaliação pré-operatória de cirurgia bariátrica. Até o momento, a biopsia hepática é o procedimento com maior precisão para tal diagnóstico. OBJETIVO: Avaliar o escore de fibrose hepática em doença hepática gordurosa não-alcoólica em pacientes com obesidade mórbida na população brasileira. MÉTODOS: Foram incluídos 158 pacientes com obesidade mórbida submetidos a cirurgia bariátrica. Idade, índice de massa corporal, hiperglicemia, albumina, contagem de plaquetas e razão AST/ALT foram aplicados à fórmula do escore de fibrose. Valores acima de 0,676 indicavam fibrose avançada e abaixo de - 1,455 indicavam ausência de fibrose. Estes valores foram comparados com os achados de biopsia hepática realizados no intra-operatório. RESULTADOS: A presença de