Thai Journal of Gastroenterology

Article :
Combination of Bard Scoring System and Transient Elastography or Serum Hyaluronic Acid for Diagnosis of Severe Fibrosis in Patients with NAFLD

Author :
Soontornmanokul T1
Treeprasertsuk S1
Komolmit P1
Tangkijvanich P2
Werawatganon D3
Klaikaew N4
Kongtaweelert P5
Kullavanich P1

Abstract :
Background: Liver fibrosis is the main prognostic factor of liver injury in non alcoholic fatty liver disease (NAFLD), and liver biopsy is the gold standard method to assess the severity of fibrosis. Currently, BARD scoring system is an easily tool for predicting liver fibrosis based on available clinical data. Additionally serum hyaluronic acid (HA) and transient elastography (TE) have also been shown as promising non-invasive tools in detecting severe fibrosis among patients with NAFLD. Objective: To determine whether the combination of BARD score and serum HA or TE can reliably predict the severity of liver fibrosis in Thai NAFLD patients Methods: A prospective study was conducted in 39 patients with histological proven NAFLD in King Chulalongkorn Memorial Hospital (KCMH), Thailand during July 2010 and February 2012. Demographic data, metabolic profile, BARD score were collected. Liver fibrosis was graded according to Brunt scoring system. Se- rum hyaluronic acid level was measured by ELISA. Transient elastography with FibroScan(tm) was performed. Results: The 43.6% of our patients were female with the mean age at 45.2 ± 14.0 yrs. Twenty patients (51.3%) had ≥ 3 components of metabolic syndrome. According to the histological result, 26 patients (66.7%) had severe liver fibrosis (F2-4). Multivariate logistic analysis showed that higher NAS score and older age were the significant predictors of severe liver fibrosis in NAFLD patients with OR 3.9 and 1.1, respectively (p<0.05). The prediction levels expressed by area under the ROC curve (AUC) of serum HA and TE for severe liver fibrosis in NAFLD were 0.81 and 0.83. For predicting severe liver fibrosis in patients with NAFLD, the cut-off value of 76 ng/ mL of serum HA provided the sensitivity, specificity, PPV, NPV and accuracy were 91.3%, 60%, 84%, 66.7%, and 77.5%. The cut-off value of 6.5 kPa of TE found 87%, 50%, 87%, 50% and 79.3%, respectively. By using the combination of BARD score and serum HA or TE, at least 50% of our patients can be avoided from liver biopsy. Conclusion: Combination of BARD score and serum hyaluronic acid or transient elastography is a promising tool with very high positive predictive value (84.6%) for predicting severe liver fibrosis in NAFLD patients.

Keyword :
Bard scoring system, transient elastography, serum hyaluronic acid, liver fibrosis, NAFLD

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