Serum Ferritin in patients with hepatic fibrosis on top of NAFLD

Abstract

Nonalcoholic fatty liver disease is a common condition associated with metabolic syndrome. It is the most common cause of elevated liver enzymes in U.S. adults, and is diagnosed after ruling out other causes of steatosis (fatty infiltration of liver), particularly infectious hepatitis and alcohol abuse. Due to the difficulties in extensive application of liver biopsy, many anthropometric, clinical and laboratory features in NASH patients were investigated for their currency and worthiness in the prediction of liver fibrosis. Serum ferritin levels are commonly elevated in patients with nonalcoholic fatty liver disease (NAFLD) because of systemic inflammation, increased iron stores, or both. Our aim in this study was to reveal the value of serum ferritin in prediction of hepatic fibrosis in non-alcoholic fatty liver disease patients. All subjects included in the study are free from any other cause of liver disease such as viral hepatitis, schistosomiasis, autoimmune, drug induced, hemochromatosis, Wilson disease and decompensated liver cirrhosis. The study included 113patients who were classified into 3 groups: • Group I: 30 healthy subjects as control with no evidence of NAFLD by liver biopsy. • Group II: 31 NAFLD patients without fibrosis proved by liver biopsy. • Group III: 52 patients with hepatic fibrosis on top of NAFLD proved by liver biopsy. patients under study were subjected to detailed History taking, full physical examination, including abdominal examination, waist circumference measurement and BMI and laboratory investigations included Complete Blood Count (CBC), Liver function tests: Alanine Transaminase (ALT), Aspartate Transaminase (AST), Serum Bilirubin, Serum Albumin and Prothrombin Time (PT), Full lipid profile,Viral marker e.g. HBsAg, HCV Ab, autoimmune markers: ANA, ASMA, Bilharzial Antibodies, Ceruloplasmin, serum and urinary Copper. FIB4 was calculated and liver biopsy was done for all patients. In addition, all patients and controls were assessed for serum ferritin level using a commercially available ELISA kit. The study has demonstrated that hepatic fibrosis patients on top of NAFLD had a highly significant increase serum ferritin levels in hepatic fibrosis patients than controls while there is no significant difference in serum ferritin level among NAFLD patients than controls. Serum ferritin was significantly positively correlated with creatinine and serum iron and highly significantly positively correlated with alkaline phosphatase among controls. Serum ferritin was significantly positively correlated with weight, waist circumference, total cholesterol, FBS and HbA1c, significantly negatively correlated with platelets and highly significantly positively correlated with ALT among NAFLD patients. Serum ferritin was highly significantly positively correlated with age, weight, BMI, waist circumference, TG, FBS,2hPP ,HbA1c, AST, ALT, T.bilirubin, D.bilirubin, PTT, INR,FIB4, serum Iron and steatosis , highly significantly negatively correlated with platelets , significantly negatively correlated with albumin and significantly positively correlated with PT among hepatic fibrosis patients. Diagnostic performance study using ROC curve analysis and multiple cut-off levels of serum ferritin for discriminating NAFLD patients from those controlsrevealed that an optimum cut-off level of 39.5 ng/ml was the best to predict NAFLD with diagnostic sensitivity and specificity of (74%, 33% respectively) and area under the curve=0.642. Another diagnostic performance study using ROC curve analysis and multiple cut-off levels of serum ferritin for discriminating NAFLD patients with fibrosis from those without fibrosisrevealed that an optimum cut-off level of 51.95 ng/ml was the best to predict fibrosis on top of NAFLD with diagnostic sensitivity and specificity of (65%, 60% respectively) and area under the curve=0.658. BMI, TLC and Alkaline phosphatase were independent predictors of occurrence of NAFLD and TLC was independent predictor of occurrence of fibrosis on top of NAFLD.