Non-alcoholic fatty liver disease laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(17 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Non alcoholic fatty liver disease}}
{{Non alcoholic fatty liver disease}}
'''Editor in Chief''': Elliot Tapper, M.D., Beth Israel Deaconess Medical Center, [[User:C Michael Gibson |C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]
{{CMG}}; {{AE}} {{MKK}}
 
{{PleaseHelp}}
 
==Overview==
==Overview==
Elevated liver function tests are common. Typically, one finds a 2-4 fold elevation of the ALT above the normal limit and an ALT/AST ratio of greater than 1.This ratio is imperfect, as AST tends to rise with the degree of fibrosis. The Ratio of Aspartate Aminotransferase to Alanine Aminotransferase: Potential Value in Differentiating Nonalcoholic Steatohepatitis From Alcoholic Liver disease.Furthermore, high ALT values within the reference range (less than 40 IU) are still predictive of NAFLD/NASH. Higher Concentrations of Alanine Aminotransferase within the Reference Interval Predict Nonalcoholic Fatty Liver Disease.Another blood test that can be elevated is the ferritin. Typically, and except in very advanced disease, the liver's synthetic function is intact with normal albumin and INR.
There are no specific diagnostic laboratory findings associated with non alcoholic fatty liver disease. Laboratory findings include abnormal liver function tests but are unspecific. Other laboratory tests are generally performed  to rule out other diagnosis.


When considering NAFLD, other tests are generally performed, including those for associated conditions (e.g. glucose, hemoglobin A1C) and those to distinguish this disease from viral [[hepatitis]]. Additionally, autoimmune causes are ruled out with serology. [[Thyroid-stimulating hormone|TSH]] is warranted, as [[hypothyroidism]] is more prevalent in NASH patients.
==Laboratory Findings==


==Laboratory Findings==
*There is no specific laboratory findings diagnostic for non alcoholic fatty liver disease.<ref name="urlNonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers - Noureddin - 2012 - Clinical Liver Disease - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/cld.65/pdf |title=Nonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers - Noureddin - 2012 - Clinical Liver Disease - Wiley Online Library |format= |work= |accessdate=}}</ref><ref name="urlNonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH)">{{cite web |url=https://www.uptodate.com/contents/nonalcoholic-fatty-liver-disease-nafld-including-nonalcoholic-steatohepatitis-nash-beyond-the-basics |title=Nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH) |format= |work= |accessdate=}}</ref>
*Liver function tests
**Typical finding include a 2-4 fold elevation of the&nbsp;[[ALT]]&nbsp;
**An [[ALT]]/[[AST]] ratio of greater than 1.


*There is no significant diagnostic laboratory findings associated with NAFLD.
* Evaluation for alternative causes of liver disease should be performed.
** These include&nbsp;[[HCV|HCV serology]], serologies for [[autoimmune hepatitis]], and&nbsp;copper studies&nbsp;including serum [[ceruloplasmin]] and 24-hour urinary copper if [[Wilson's disease|Wilson disease]] is suspected.


*An elevated concentration of serum aspartate transaminase ('''AST''') and alanine transaminase ('''ALT''') is not reliable for the diagnostic of NAFLD.
* [[Fasting plasma glucose]]&nbsp;testing following an overnight fast is important to look for [[hyperglycemia]], which is an indicator of [[insulin resistance]].
*Ultrasound(USG), computer tomography (CT) and magnetic resonance imaging (MRI) are usually not a reliable approach to diagnosis for patients with NAFLD.
** Fasting [[insulin]] levels can confirm [[hyperinsulinemia]] and [[insulin resistance]]
* [[Lipid]] levels (&nbsp;serum [[cholesterol]]&nbsp;and&nbsp;fasting [[triglycerides]]&nbsp;) should be evaluated
** [[Dyslipidemia]], beside being a very common finding in NAFLD, is a risk factor that can be modified by dietary and/or pharmacologic intervention.
* Iron studies&nbsp;(in particular elevated [[ferritin]] and transferring saturation) are often abnormal in NAFLD
* Some patients with NAFLD may have low titers of [[Autoimmune disease|autoimmune]] [[antibodies]].
* [[Biomarkers]]
** CK18 represents a promising [[biomarker]] for evaluation of the presence of NASH.
** A defining characteristic of NASH is [[cellular]] death, and [[serum]] CK18 levels had been shown to correlate with [[steatohepatitis]].


==Liver Biopsy==
[[Non-alcoholic fatty liver disease]], especially if with cirrhosis, may be associated with [[thrombocytopenia]]<ref name="pmid34312112">{{cite journal| author=Rivera-Álvarez M, Córdova-Ramírez AC, Elías-De-La-Cruz GD, Murrieta-Álvarez I, León-Peña AA, Cantero-Fortiz Y | display-authors=etal| title=Non-alcoholic fatty liver disease and thrombocytopenia IV: its association with granulocytopenia. | journal=Hematol Transfus Cell Ther | year= 2021 | volume=  | issue=  | pages=  | pmid=34312112 | doi=10.1016/j.htct.2021.06.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34312112  }} </ref><ref name="pmid31575467">{{cite journal| author=Panke CL, Tovo CV, Villela-Nogueira CA, Cravo CM, Ferreira FC, Rezende GFM | display-authors=etal| title=Evaluation of thrombocytopenia in patients with non-alcoholic fatty liver disease without cirrhosis. | journal=Ann Hepatol | year= 2020 | volume= 19 | issue= 1 | pages= 88-91 | pmid=31575467 | doi=10.1016/j.aohep.2019.05.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31575467  }} </ref>.


even though other exams may endorse a diagnosis of NASH, every now and then a liver biopsy is required to affirm it.Liver biopsy remains the gold standard for diagnosing
== Fibrosis score ==
NASH and assessing the degree of fibrosis in patients with
A fibrosis score can be obtained via:
NAFLD. A liver biopsy can also assist decide the severity of inflammation, detect liver scarring (fibrosis or, when extreme, cirrhosis), and may provide clues approximately the future direction of the circumstance.moreover, biopsy-tested
* Liver biopsy. Various scoring systems exist including the Ishak; however, Ishak deems cirrhosis at a score of 5 or 6<ref name="pmid7560864">{{cite journal| author=Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F | display-authors=etal| title=Histological grading and staging of chronic hepatitis. | journal=J Hepatol | year= 1995 | volume= 22 | issue= 6 | pages= 696-9 | pmid=7560864 | doi=10.1016/0168-8278(95)80226-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7560864  }} </ref>.
NASH patients also are candidates for greater competitive
** F0. No fibrosis
lifestyle interventions, with the intention to reduce the risk of
** F1. Fibrous portal expansion
destiny cardiovascular and liver disorder progression.Biomarkers and clinical prediction regulations for refining the
** F2. Few septa
control paradigm of NAFLD are rising. Metabolic
** F3. Bridging fibrosis. Numerous septa
syndrome and diabetes are the key determinants of superior
** F4. Cirrhosis
histological examinations in NAFLD. consequently, a liver biopsy
* Nonivasive serological liver fibrosis score such as AST to platelet ratio (APRI), and proprietary tests such as: FibroTest, FibroSure, Hepascore, and FibroSpect. An example is based on the "serum hyaluronic acid, procollagen type III N-terminal peptide, and tissue inhibitor of metalloproteinase 1"<ref name="pmid33185364">{{cite journal| author=Newsome PN, Buchholtz K, Cusi K, Linder M, Okanoue T, Ratziu V | display-authors=etal| title=A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis. | journal=N Engl J Med | year= 2021 | volume= 384 | issue= 12 | pages= 1113-1124 | pmid=33185364 | doi=10.1056/NEJMoa2028395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33185364  }} </ref>.
may be considered in this subset of patients with NAFLD.
** A score > "9.8 indicates a moderate risk of advanced fibrosis"<ref name="pmid33185364">/
until similar refinement of biomarkers and scientific prediction
** A score > "11.3 denotes a high risk of advanced fibrosis"<ref name="pmid33185364"/>
regulations, liver biopsy has to be taken into consideration in patients with
* Noninvasive imaging scores such as the Fibroscan.
NAFLD who have an increased danger of advanced fibrosis and
when the prognosis is unsure. Incremental advances in the
noninvasive analysis of NASH will preserve to form the
management paradigm of NAFLD and will alternate scientific
practice in the coming years


==References==
==References==

Latest revision as of 21:24, 2 February 2022

Non-Alcoholic Fatty Liver Disease Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Non-Alcoholic Fatty Liver Disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Non-alcoholic fatty liver disease laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Non-alcoholic fatty liver disease laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Non-alcoholic fatty liver disease laboratory findings

CDC on Non-alcoholic fatty liver disease laboratory findings

Non-alcoholic fatty liver disease laboratory findings in the news

Blogs on Non-alcoholic fatty liver disease laboratory findings

Directions to Hospitals Treating Non-alcoholic fatty liver disease

Risk calculators and risk factors for Non-alcoholic fatty liver disease laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

There are no specific diagnostic laboratory findings associated with non alcoholic fatty liver disease. Laboratory findings include abnormal liver function tests but are unspecific. Other laboratory tests are generally performed to rule out other diagnosis.

Laboratory Findings

  • There is no specific laboratory findings diagnostic for non alcoholic fatty liver disease.[1][2]
  • Liver function tests
    • Typical finding include a 2-4 fold elevation of the ALT 
    • An ALT/AST ratio of greater than 1.

Non-alcoholic fatty liver disease, especially if with cirrhosis, may be associated with thrombocytopenia[3][4].

Fibrosis score

A fibrosis score can be obtained via:

  • Liver biopsy. Various scoring systems exist including the Ishak; however, Ishak deems cirrhosis at a score of 5 or 6[5].
    • F0. No fibrosis
    • F1. Fibrous portal expansion
    • F2. Few septa
    • F3. Bridging fibrosis. Numerous septa
    • F4. Cirrhosis
  • Nonivasive serological liver fibrosis score such as AST to platelet ratio (APRI), and proprietary tests such as: FibroTest, FibroSure, Hepascore, and FibroSpect. An example is based on the "serum hyaluronic acid, procollagen type III N-terminal peptide, and tissue inhibitor of metalloproteinase 1"[6].
    • A score > "9.8 indicates a moderate risk of advanced fibrosis"<ref name="pmid33185364">/
    • A score > "11.3 denotes a high risk of advanced fibrosis"[6]
  • Noninvasive imaging scores such as the Fibroscan.

References

  1. ↑ "Nonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers - Noureddin - 2012 - Clinical Liver Disease - Wiley Online Library".
  2. ↑ "Nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH)".
  3. ↑ Rivera-Álvarez M, Córdova-Ramírez AC, Elías-De-La-Cruz GD, Murrieta-Álvarez I, León-Peña AA, Cantero-Fortiz Y; et al. (2021). "Non-alcoholic fatty liver disease and thrombocytopenia IV: its association with granulocytopenia". Hematol Transfus Cell Ther. doi:10.1016/j.htct.2021.06.004. PMID 34312112 Check |pmid= value (help).
  4. ↑ Panke CL, Tovo CV, Villela-Nogueira CA, Cravo CM, Ferreira FC, Rezende GFM; et al. (2020). "Evaluation of thrombocytopenia in patients with non-alcoholic fatty liver disease without cirrhosis". Ann Hepatol. 19 (1): 88–91. doi:10.1016/j.aohep.2019.05.011. PMID 31575467.
  5. ↑ Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F; et al. (1995). "Histological grading and staging of chronic hepatitis". J Hepatol. 22 (6): 696–9. doi:10.1016/0168-8278(95)80226-6. PMID 7560864.
  6. ↑ 6.0 6.1 Newsome PN, Buchholtz K, Cusi K, Linder M, Okanoue T, Ratziu V; et al. (2021). "A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis". N Engl J Med. 384 (12): 1113–1124. doi:10.1056/NEJMoa2028395. PMID 33185364 Check |pmid= value (help).

Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Non-alcoholic_fatty_liver_disease_laboratory_findings&oldid=1719193"