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.
Liver Biopsy
- Even though other exams may endorse a diagnosis of NASH, every now and then a liver biopsy is required to affirm it[1].
- Liver biopsy remains the gold standard for diagnosing NASH and assessing the degree of fibrosis in patients with 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[2].
- Moreover, biopsy-tested NASH patients also are candidates for greater competitive lifestyle interventions, with the intention to reduce the risk of destiny cardiovascular and liver disorder progression.
- Biomarkers and clinical prediction regulations for refining the control paradigm of NAFLD are rising. Metabolic syndrome and diabetes are the key determinants of superior histological examinations in NAFLD.
- Consequently, a liver biopsy may be considered in this subset of patients with NAFLD.
- Until similar refinement of biomarkers and scientific prediction regulations, liver biopsy has to be taken into consideration in patients with 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.