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Liver
Research
Non-invasive markers of liver fibrosis in fatty liver disease are unreliable in people of South Asian descent
  1. Sampath De Silva1,
  2. Wenhao Li1,
  3. Polychronis Kemos1,
  4. James H Brindley1,
  5. Jibran Mecci1,
  6. Salma Samsuddin1,
  7. Joanne Chin-Aleong2,
  8. Roger M Feakins2,
  9. Graham R Foster1,
  10. Wing-Kin Syn1,3,4,
  11. William Alazawi1
  1. 1 Liver Unit, Blizard Institute, QueenMary University of London, London, UK
  2. 2 Department of Histopathology, Bart’s Health NHS Trust, London, UK
  3. 3 Section of Gastroenterology, Ralph H Johnson Veterans Affairs Medical Center, Charleston, USA
  4. 4 Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, USA
  1. Correspondence to Dr William Alazawi, Liver Unit, Blizard Institute, QueenMary, University of London, E1 2AT, London; w.alazawi{at}qmul.ac.uk

Abstract

Objective Liver biopsy is the most accurate method for determining stage and grade of injury in non-alcoholic fatty liver disease (NAFLD). Given risks and limitations of biopsy, non-invasive tests such as NAFLD fibrosis score, aspartate transaminase (AST) to platelet ratio index, Fib-4, AST/alanine transaminase ratio and BARD are used. Prevalence and severity of NAFLD and metabolic syndrome vary by ethnicity, yet tests have been developed in largely white populations. We tested our hypothesis that non-invasive tests that include metabolic parameters are less accurate in South Asian compared with white patients.

Design Retrospective cross-sectional.

Setting Specialist liver centre.

Patients Patients with histologically confirmed NAFLD.

Interventions Scores calculated using clinical data taken within 1 week and compared with histology (Kleiner).

Main outcome measures Diagnostic test characteristics.

Results 175 patients were identified. South Asians (n=90) were younger, had lower body mass index and lower proportion of obesity compared with white patients (n=79), with comparable rates of diabetes and liver injury. Tests are less sensitive at detecting advanced fibrosis in South Asian compared with white patients. Relative risk of correct diagnosis in white patients compared with South Asians is 1.86 (95% CI 1.4 to 2.6). In binary logistic regression models, ethnicity and platelet count predicted accuracy. Transient elastography was equally and highly accurate in both ethnicities.

Conclusions Blood test-based non-invasive scores are less accurate in South Asian patients, irrespective of metabolic parameters. Ethnicity should be considered when devising risk-stratification algorithms for NAFLD.

  • nonalcoholic steatohepatitis
  • fibrosis
  • fatty liver
  • liver biopsy

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/flgastro-2017-100865

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    Footnotes

    • Contributors SDS collected data and drafted the manuscript. WL, JHB, AJ and SS collected data. PK analysed results. JCA, RF, GRF and WA revised the manuscript. WA designed the study.

    • Funding Funded by the Diabetes Research and Wellness Foundation and supported by the North Thames Clinical Research Network. WA is in receipt of grants from the Medical Research Council and Liver and Pancreas Research UK.

    • Competing interests None declared.

    • Patient consent The study was approved by Barts Health NHS trust clinical standards and audit department as a service evaluation of NILTs and therefore specific informed consent was not required or taken.

    • Ethics approval Barts Health NHS Trust Clinical Standards and Audit Department.

    • Provenance and peer review Not commissioned; externally peer reviewed.