Clinical characteristics associated with hepatic steatosis on ultrasonography in patients with elevated alanine aminotransferase
Keywords:
Fatty liver, Alanine transaminase, Ultrasonography, Diabetes mellitus, Body mass indexAbstract
CONTEXT AND OBJECTIVE: The main causes of hepatic steatosis (HS) are alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD). Although liver biopsy is the gold standard for NAFLD diagnosis, the finding of abnormal aminotransferases in abstinent individuals, without known liver disease, suggests the diagnosis of NAFLD in 80-90% of the cases. Identification of clinical factors associated with HS on abdominal ultrasound may enable diagnoses of fatty liver non-invasively and cost-effectively. The aim here was to identify clinical variables associated with HS in individuals with elevated alanine aminotransferase (ALT) levels. DESIGN AND SETTING: Cross-sectional study in a single tertiary care center. METHODS: Individuals with elevated ALT, serologically negative for hepatitis B and C, were evaluated by reviewing medical files. Patients who did not undergo abdominal ultrasonography were excluded. RESULTS: Among 94 individuals included, 40% presented HS on ultrasonography. Compared with individuals without HS, those with fatty liver were older (P = 0.043), with higher body mass index (BMI) (P = 0.003), diabetes prevalence (P = 0.024), fasting glucose levels (P = 0.001) and triglycerides (P = 0.003). Multivariate analysis showed that BMI (odds ratio, OR = 1.186; 95% confidence interval, CI: 1.049-1.341; P = 0.006) and diabetes mellitus (OR = 12.721; 95% CI: 1.380-117.247; P = 0.025) were independently associated with HS. CONCLUSIONS: Simple clinical findings such as history of diabetes and high BMI may predict the presence of HS on ultrasonography in individuals with elevated ALT and negative serological tests for hepatitis.
Downloads
References
Browning J, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40(6): 1387-95.
Clark JM, Diehl AM. Defining nonalcoholic fatty liver disease: implications for epidemiologic studies. Gastroenterology. 2003;124(1):248-50.
Hamer OW, Aguirre DA, Casola G, et al. Fatty liver: imaging patterns and pitfalls. Radiogra- phics. 2006;26(6):1637-53.
El-Zayadi AR. Hepatic steatosis: a benign disease or a silent killer. World J Gastroenterol. 2008;14(26):4120-6.
Hui JM, Kench JG, Chitturi S, et al. Long-term outcomes of cirrhosis in nonalcoholic steato- hepatitis compared with hepatitis C. Hepatology. 2003;38(2):420-7.
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221-31.
Vuppalanchi R, Chalasani N. Nonalcoholic fatty liver disease and nonalcoholic steato- hepatitis: Selected practical issues in their evaluation and management. Hepatology. 2009;49(1):306-17.
Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastroenterology. 2002;122(6):1649-57.
Sanyal AJ; American Gastroenterological Association. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123(5):1705-25.
Marchesini G, Bugianesi E, Forlani G , et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37(4):917-23.
Bedogni G, Miglioli L, Masutti F, et al. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005;42(1):44-52.
Szczepaniak L, Nurenberg P, Leonard D, et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab. 2005;288(2):E462-8.
Hilden M, Christoffersen P, Juhl E, Dalgaard JB. Liver histology in a ‘normal’ population-
-examinations of 503 consecutive fatal traffic casualties. Scand J Gastroenterol. 1977;12(5):593-7.
Adams LA, Angulo P, Lindor KD. Nonalcoholic fatty liver disease. CMAJ. 2005;172(7):899- 905.
Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med. 1993;118(2):96-8.
Maharaj B, Maharaj RJ, Leary WP, et al. Sampling variability and its influence on the diagnos- tic yield of percutaneous needle biopsy of the liver. Lancet. 1986;1(8480):523-5.
Arun J, Jhala N, Lazenby AJ, Clements R, Abrams GA. Influence of liver biopsy heterogeneity and diagnosis of nonalcoholic steatohepatitis in subjects undergoing gastric bypass. Obes Surg. 2007;17(2):155-61.
Charatcharoenwitthaya P, Lindor KD. Role of radiologic modalities in the management of non-alcoholic steatohepatitis. Clin Liver Dis. 2007;11(1):37-54, vii.
Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis. 2001;21(1):17-26.
Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver dise- ase with insulin resistance. Am J Med. 1999;107(5):450-5.
Ryan P, Blanco F, García-Gascó P, et al. Predictors of severe hepatic steatosis using abdomi- nal ultrasound in HIV-infected patients. HIV Med. 2009;10(1):53-9.
Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology. 1990;12(5):1106-10.
Silverman JF, O’Brien KF, Long S, et al. Liver pathology in morbidly obese patients with and without diabetes. Am J Gastroenterol. 1990;85(10):1349-55.
Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastro- enterology. 2002;123(4):1367-84.
Krier M, Ahmed A. The asymptomatic outpatient with abnormal liver function tests. Clin Liver Dis. 2009;13(2):167-77.
