Clinical characteristics associated with hepatic steatosis on ultrasonography in patients with elevated alanine aminotransferase

Abstract

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 liverwere 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.RESUMO CONTEXTO E OBJETIVO: Doença hepática alcoólica e doença hepática esteatótica não alcoólica (DHenA) são as principais causas de esteatose hepática (eH). Apesar de a biópsia hepática ser o método de escolha para diagnóstico DHenA, o achado de aminotransferases elevadas em indivíduos abstêmios, sem doença hepática conhecida, sugere o diagnóstico de DHenA em 80-90% dos casos. A identificação de variáveis clínicas associadas à eH na ultrassonografia abdominal pode permitir o diagnóstico de DHenA de forma não invasiva e custo-efetiva. O objetivo foi identificar variáveis clínicas associadas à eH em indivíduos com níveis elevados de alanina aminotransferase (ALT).TIPO DE ESTUDO E LOCAL: estudo transversal em um único centro de atendimento terciário.MÉTODOS: indivíduos com ALT elevada e sorologias negativas para os vírus de hepatite B e C foram avaliados por meio de revisão de prontuários.Os pacientes não submetidos à ultrassonografia foram excluídos. RESULTADOS:Foram incluídos 94 indivíduos, 40% deles com eH à ultrassonografia. Quando comparados aos indivíduos sem eH, aqueles com eH apresentaram maior prevalência de diabetes (P = 0,024), maiores idade (P = 0,043) e índice de massa corpórea (iMC) (P = 0,003), glicemia de jejum mais elevada (P = 0,001) e triglicerídeos mais elevados (P = 0,003). A análise multivariada evidenciou que o iMC (odds ratio, OR = 1,186, 95% intervalo de confi...

Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

“…In the present study, the presence of LS on abdominal ultrasound was associated with fasting insulin and total cholesterol, similar to fi ndings previously reported by other authors in non-HBV patients 25,[27][28][29] , indicating that LS is related to disordered metabolism of blood glucose and lipids. Although BMI data were available only in a small subset of patients (n = 19), these data revealed a signifi cant difference between the two study groups.…”

“…In these studies, the sensitivity ranged from 60% to 94% and the specifi city from 84% to 97% [21][22][23][24] . In a sample of 94 Brazilian individuals with elevated ALT, 40% presented LS on ultrasound, and both the BMI and history of diabetes were independently associated with the presence of LS 25 . Almost one-third of a sample of 2,287 American subjects evaluated by Browning et al presented with LS according to magnetic resonance imaging (31%).…”

Sonographic hepatorenal ratio: A noninvasive method to diagnose nonalcoholic steatosis

“…Nonalcoholic fatty liver disease (NAFLD), a common cause of chronic liver disease and largely associated with the current epidemics of obesity and diabetes, refers to a spectrum of liver damages ranging from simple steatosis to steatohepatitis and subsequently fibrosis, and progression to cirrhosis and liver cancer 1, 2. NAFLD is usually found incidentally after recognition of a mild elevation of aminotransferase levels or steatosis on routine clinical interpretation of ultrasound (US) performed for other purposes, and increasingly it is recognized as the hepatic manifestation of metabolic syndrome 3–6…”

Comparative diagnostic study of biomarkers using FibroMax™ and pathology for prediction of liver steatosis in patients with chronic hepatitis C virus infection: an Egyptian study

“…Hyperechogenicity is observed on ultrasound examination of the liver parenchyma in the presence of hepatic steatosis, and is associated with changes in echo texture, vascular blurring, and deep attenuation. This corresponds to steatotic infiltration greater than 30% in both liver lobes, with a sensitivity of 60%–95% and a specificity of 77%–100% 8,9…”