The role of non-invasive scores in determining the liver fibrosis in NAFLD and psoriatic patients

Abstract

According to recent data, psoriatic patients have an increased prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome, compared with the general population. In some published studies, the severity and presence of psoriasis disease were correlated with the severity of NAFLD. In the current study, we aimed to compare the sensibility and specificity of the non-invasive scores and liver biopsy in determining fibrosis in patients with NAFLD and moderate to severe psoriasis. We performed the scientific research from June 2014-December 2017 and we included 71 patients: 40 patients with NAFLD and 31 patients with moderate to severe psoriasis according to Psoriasis Area and Severity Index (PASI) score and NAFLD, who received Etanercept treatment for at least one year. Based on the clinical and laboratory data, we calculated the following scores for fibrosis: body mass index (BMI), aspartate aminotransferase (AST)∕alanine aminotransferase (ALT) ratio, diabetes (BARD) score, Fibrosis-4 (FIB-4) score, and NAFLD fibrosis score (NFS). For liver biopsy, we used the Menghini technique. By calculating Kendall's test, we also observed a strong direct correlation between the degree of fibrosis and FIB-4 (tau=0.558) and NFS (tau=0.490) scores, with a critical statistical impact, and the lack of a correlation with the BARD score (tau=0.095; p=0.332). The hepatic biopsy allowed the more accurate establishment of the role of the non-invasive tests in the diagnosis of the lesions of steatosis, steatohepatitis, and hepatic fibrosis. The non-invasive tests are most useful for the exclusion of the evolution lesions and for the confirmation of the advanced stages of the disease. Among these, the NFS score proved a high statistically significant correlation (p<0.0001) with the fibrosis histological lesions.

Figure 1

NAFLD F1 stage: macro- and microvesicular steatosis, hepatocyte ballooning degeneration, portal space fibrosis and lymphoplasmocytic inflammatory infiltrate (HE staining, ×200). NAFLD: Non-alcoholic fatty liver disease

Figure 2

NAFLD F1 stage: macro- and microvesicular steatosis, hepatocyte ballooning degeneration, portal space fibrosis and lymphoplasmocytic inflammatory infiltrate (Masson’s trichrome staining, ×100). NAFLD: Non-alcoholic fatty liver disease

Figure 3

NAFLD F2 stage: macro- and microvesicular steatosis, hepatocyte ballooning degeneration, perisinusoidal fibrosis, portal space lymphoplasmocytic inflammatory infiltrate (HE staining, ×100). NAFLD: Non-alcoholic fatty liver disease

Figure 4

NAFLD F3 stage: bridging fibrosis (HE staining, ×40). NAFLD: Non-alcoholic fatty liver disease

Figure 5

(a) Steatohepatitis F3 stage: porto-central fibrous septa, hepatocyte degeneration and steatosis (Masson’s trichrome staining, ×100); (b) Bridging fibrosis F4 stage (Argentic staining, ×100).

Figure 6

Macronodular cirrhosis. HE staining, ×40

Figure 7

The distribution of patients depending on the BARD score and the fibrosis (F) degree. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BARD: BMI, AST/ALT ratio, diabetes; BMI: Body mass index