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Review
. 2020 Aug 21:12:125-138.
doi: 10.2147/HMER.S265473. eCollection 2020.

Identifying High-Risk NASH Patients: What We Know so Far

Marten Schulz  1 , Frank Tacke  1
Affiliations
Review

Identifying High-Risk NASH Patients: What We Know so Far

Marten Schulz et al. Hepat Med. .

Abstract

Steatosis is a condition of hepatic fat overload that is associated with overweight and the metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) has become the most common liver disease with a global impact on healthcare. A proportion of NAFLD patients develops nonalcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis or hepatocellular carcinoma (HCC). Identifying patients at risk for potentially life-threatening complications is crucial in their prevention, surveillance and treatment. In addition to hepatic disease progression (cirrhosis, portal hypertension, HCC), NAFLD patients are also at risk of cardiovascular and metabolic diseases as well as extrahepatic malignancies. Liver fibrosis is related to morbidity and mortality in NASH patients, and biomarkers, imaging techniques (ultrasound, elastography, MRI) as well as liver biopsy help in diagnosing fibrosis. In this review, we discuss the tools for identifying patients at risk and their reasonable application in clinical routine in order to stratify prevention and treatment of this emerging disease.

Keywords: NAFLD; cirrhosis; elastography; fibrosis; hepatocellular carcinoma; liver-stiffness measurement.

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Conflict of interest statement

Professor Frank Tacke reports grants from BMS, Allergan, Inventiva, Galapagos, personal fees from Allergan, Pfizer, Novartis, NGM, Bayer, Gilead, Falk, Abbvie, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Risk factors for NAFLD progression. Sedentary lifestyle with over-alimentation, obesity and diabetes are the main risk factors that promote disease severity progression from simple steatosis to NASH, fibrosis (stages F1-F3) and cirrhosis.
Figure 2
Figure 2
Transient elastography: TE (Fibroscan, Echosens): Display of a reconstructed view of the wavefront that passes through the liver from the handheld probe (M or XL). Controlled attenuation parameter (CAP) measurement is displayed on the left-hand side.
Figure 3
Figure 3
SWE measurement: SWE (Aplio 500, Toshiba) in a right intercostal probe position, LSM in region of interest (ROI) displayed by the white circle in the colour overlay style shearwave measurement. The color scale shows the distribution of the measured elasticity. (A) SWE in a 20-year-old female with a healthy liver; LSM was 4.9 kPa. (B) SWE in a 66-year-old female with NASH fibrosis; LSM was 8.7 kPa.
Figure 4
Figure 4
pSWE in NAFLD: pSWE (Arietta V70, HITACHI) in a right intercostal probe position, LSM in region of interest (ROI) displayed by the yellow box. (A) pSWE in a 35-year-old male with a healthy liver; LSM was 2.88 kPa. (B) pSWE in a 84-year-old male with NASH fibrosis; LSM was 9.28 kPa.
Figure 5
Figure 5
Magnetic resonance elastography: MRE of the liver in a cirrhotic patient. Stiffness measures are depicted in a quantitative colour scale.
See this image and copyright information in PMC

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