Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to B
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Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to Bariatric and Metabolic Surgery Anthony Antipass 1 & Andrew Austin 2 & Sherif Awad 2 & David Hughes 2,3 & Iskandar Idris 1,2
# The Author(s) 2020
Abstract Bariatric and metabolic surgery is associated with significant improvement in obesity-related comorbidities, but for patients with nonalcoholic fatty liver disease (NAFLD), clinical outcomes are dependent on the severity of liver disease, i.e. improvement of NAFLD in most patients but increased risks of fulminant hepatic failure and/or bleeding varices in patients with more advanced cirrhosis. Our study showed that absolute values of liver enzymes were poor indicator of risk of liver fibrosis. The use of AST/ALT ratio, Fib 4 or NAFLD scores were appropriate screening tools, with each risk score appearing to pick out a certain phenotype of patients based on age, BMI or individual values of ALT, AST or platelet count. There is lack of agreement in some cases between FIB-4 scores and NAFLD scores when ruling out patients at high risk of liver fibrosis. Meticulous screening of patients at risk of liver fibrosis is crucial in order to reduce the risk of liver-related complications following bariatric and metabolic surgery. Keywords Bariatric surgery . NAFLD, . Liver function
Introduction Obesity is associated with a plethora of associated chronic comorbidities with non-alcoholic fatty liver disease (NAFLD) being the most common cause of chronic liver disease, with a prevalence of between 20 and 30% in the general population [1], increasing to up to 90% in severely obese patients [1]. NAFLD represents a spectrum of disease, of which a subset with more severe liver disease; namely, non-alcoholic steatohepatitis (NASH) may progress to cirrhosis [2, 3], where cumulative liver injury and necroinflammation result in fibrogenesis of the liver, associated with portal hypertension and hepatic synthetic dysfunction [3]. While bariatric surgery plays an important role in
* Iskandar Idris [email protected] 1
School of Medicine, University of Nottingham, Nottingham, UK
2
University Hospitals of Derby And Burton Foundation Trust, Derby, UK
3
Division of Medical Sciences & Graduate Entry Medicine,School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
improving NAFLD, performing bariatric surgery in patients with undiagnosed NAFLD with advanced cirrhosis has been associated with severe repercussions, leading to sepsis, portal vein thrombosis, anastomotic leak, bleeding varices, fulminant hepatic failure and peri- and post-operative mortality [4–7]. Thus, careful pre- and post-operative screening, investigation, medical optimization and follow up of patients is crucial not only to identify individuals who would otherwise not be diagnosed to have advanced liver disease, but also crucially, to improve clinical outcomes, to determine the most appropriate surgical technique
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