Serum ferritin is a discriminant marker for both fibrosis and inflammation in histologically proven non-alcoholic fatty liver disease patients
Pinelopi Manousou
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorGeorge Kalambokis
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorFederica Grillo
Department of Histopathology, Royal Free Hospital, London, UK
Search for more papers by this authorJennifer Watkins
Department of Histopathology, Royal Free Hospital, London, UK
Search for more papers by this authorElias Xirouchakis
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorMaria Pleguezuelo
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorGioacchino Leandro
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorVasiliki Arvaniti
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorGiacomo Germani
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorDavid Patch
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorVincenza Calvaruso
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorDimitri P. Mikhailidis
Department of Clinical Biochemistry, Royal Free Hospital, London, UK
Search for more papers by this authorAmar P. Dhillon
Department of Histopathology, Royal Free Hospital, London, UK
Search for more papers by this authorAndrew K. Burroughs
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorPinelopi Manousou
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorGeorge Kalambokis
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorFederica Grillo
Department of Histopathology, Royal Free Hospital, London, UK
Search for more papers by this authorJennifer Watkins
Department of Histopathology, Royal Free Hospital, London, UK
Search for more papers by this authorElias Xirouchakis
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorMaria Pleguezuelo
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorGioacchino Leandro
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorVasiliki Arvaniti
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorGiacomo Germani
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorDavid Patch
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorVincenza Calvaruso
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorDimitri P. Mikhailidis
Department of Clinical Biochemistry, Royal Free Hospital, London, UK
Search for more papers by this authorAmar P. Dhillon
Department of Histopathology, Royal Free Hospital, London, UK
Search for more papers by this authorAndrew K. Burroughs
The Royal Free Sheila Sherlock Liver Centre, Division of Surgery and Interventional Sciences, University College London, London, UK
Search for more papers by this authorAbstract
Introduction: Differentiation between steatosis and non-alcoholic steatohepatitis (NASH) in non-alcoholic fatty liver disease (NAFLD) is important as NASH progress to cirrhosis. No specific laboratory/imaging technique exists either to diagnose NASH or to select patients for liver biopsy.
Patients and methods: We evaluated serum ferritin and the features of metabolic syndrome with respect to histological inflammation and/or fibrosis in NAFLD patients. The Kleiner scoring system was used to classify NAFLD in consecutive liver biopsies. One hundred and eleven patients: median age 52.6, 64 males, obesity 62, diabetes mellitus (DM) 58, arterial hypertension 26 and hyperlipidaemia 40%.
Results: Histologically, 40.7 had fatty liver, 30.6% had borderline NASH, 28.7% had NASH and 11% had cirrhosis. Multivariate regression showed that diabetes, serum ferritin concentrations, body mass index (BMI) and AST were independently associated with NASH: together, the areas under the receiver operating characteristic (AUROC) was 0.91 (95% confidence interval 0.86–0.96); fibrosis was associated with ferritin concentrations and BMI: AUROC 0.87, portal inflammation with ferritin and DM: AUROC 0.82, while lobular inflammation was associated with BMI, DM and ferritin: AUROC 0.85.
Conclusion: Serum ferritin concentrations and BMI are strongly associated with fibrosis, portal and lobular inflammation in NAFLD patients. Both ferritin and BMI are potential discriminant markers to select patients for liver biopsy and are associated with inflammation and fibrosis.
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