Non-alcoholic fatty liver disease laboratory findings
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Editor in Chief: Elliot Tapper, M.D., Beth Israel Deaconess Medical Center, C. Michael Gibson, M.S., M.D. [1]
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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.
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. TSH is warranted, as hypothyroidism is more prevalent in NASH patients.
Laboratory Findings
- There is no significant diagnostic laboratory findings associated with NAFLD.
- An elevated concentration of serum aspartate transaminase (AST) and alanine transaminase (ALT) is not reliable for the diagnostic of NAFLD.
- Ultrasound(USG), computer tomography (CT) and magnetic resonance imaging (MRI) are usually not a reliable approach to diagnosis for patients with NAFLD.
NAFLD activity score (NAS)
| STEATOSIS | S SCORE | COMMENT |
|---|---|---|
| <5% | 0 | Refers to the quantity of surface area involved by means of steatosis as evaluated on low to medium power examination; minimum steatosis (<5%) gets a rating of 0 to keep away from giving excess weight to biopsies with little or no fatty change.[1] |
| 5–33% | 1 | |
| 34–66% | 2 | |
| >66% | 3 | |
| Lobular Inflammation | L SCORE | |
| None | 0 | Acidophil bodies are not protected by this evaluation, neither is the portal irritation.[2] |
| <2 foci | 1 | |
| 2–4 foci | 2 | |
| >4 foci | 3 | |
| Hepatocyte Balloning | B score | |
| None | 0 | |
| Few ballooned cells | 1 | The term "few" means rare however specific ballooned hepatocytes as well as cases which are diagnostically borderline. |
| Many ballooned cells | 2 | Maximum cases with distinguished ballooning additionally had Mallory's hyaline, howeverMallory's hyaline isn't scored one after the other for the NAS
. |
References
- ↑ Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.
- ↑ "Transplant Pathology Internet Services".