الفهرس | Only 14 pages are availabe for public view |
Abstract Nonalcoholic fatty liver disease (NAFLD) is an umbrella term for a range of liver Conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of NAFLD is too much fat stored in liver cells. It is estimated that NAFLD affects about 25% of the general population NAFLD diagnosis and Liver Cirrhosis involve Liver biopsy which is described as a gold standard in the evaluation of fibrosis. But this method is connected with several significant complication. The most accurate solution would be an invention of noninvasive parameters, routinely obtained platelet (PLT) parameters mean platelet volume (MPV), and plateletcrit (PCT) are potential indicators of liver fibrosis. So, the study aims to identify noninvasive, easy, and cheap markers for diagnosis and staging of NAFLD and cirrhotic patients without the need for liver biopsy. To elucidate our aim, this study was conducted on 133 patients with liver cirrhosis and non-alcoholic fatty liver patients in hepatology outpatient clinics, inpatient ward, and intensive care unit at Menoufia University hospital, during a period time from April 2022 to May 2023. All patients were divided into three groups as follows: group (I): NAFLD patient in different stages (steatosis and hepatic steatosis and fibrosis) based on NAFLD criteria, group (II): Cirrhotic patients based on history and examination and ultrasound or upper endoscopy if present and group (III): Apparently healthy control. The controls are recruited from patients who are present for getting routine check-ups. All patients included in the study were subjected to the following: Full history including Age, Gender. Anthropometric examination including Weight, Height and BMI and Waist circumference. Routine investigations as CBC especially all platelet indices (PLT, PCT, MPV, PDW), liver function tests (AST, ALT, PT, INR, ALP, GGT, Albumin, Bilirubin) and lipid profile (CL, TAG, HDL, LDL). Indirect Indices of liver fibrosis include the following AAR (AST to ALT Ratio), APRI (AST TO PLT Ratio Index), NAFLD fibrosis score was used in the NAFLD group, BARD score was used in the NAFLD group, MELD score: (Model of End-stage Liver Disease) score was used in alcoholic liver cirrhosis patients (ALC), FIB 4 index: (Age (years)×AST (U/L)/[PLT (109/L)×ALT1/2 (U/L)]), GPR (GGT to PLT Ratio) and FI (Fibrosis index). Imaging: Pelvi-abdominal US and upper GIT endoscopy for esophageal varices. The results of this study could be summarized as follows: The studied groups were matched regarding age and gender and height there were significant higher mean values of weight and BMI and waist circumference in NAFLD than cirrhotic group and control group (p1 and p2 <0.001; respectively) ,but there was no significant Between cirrhotic and control group regarding BMI and WC (p3=0.216,0.294, respectively) ,there were significance higher prevelance of diabetes and hypertension in NAFLD and cirrhotic than control group and higher prevelance of ascites and bilateral lower limb edema in cirrhotic group than both NAFLD and control group. As regards PCT It was significantly higher in both NAFLD and cirrhotic groups than the control group (p2=0.013 and p3<0.001; respectively). However, PCT was significantly lower in NAFLD group than the cirrhotic group (p1=0.013). MPV was significantly higher in NAFLD group than both the cirrhotic and the control group (p1<0.001 and p2<0.001; respectively). As regards PDW it was significantly higher in both NAFLD and CIRRHOTIC groups than control groups (p2= 0.209 and p3 = 0.409 respectively). And no significant difference between NAFLD and cirrhotic group (p1= 0.981). AST/PLT ratio and FIB4 indices were significantly higher in NAFLD group than the cirrhotic group (p<0.001). There was a significant higher percentage of patients with BARD score ≥2 in cirrhotic group than in NAFLD group (p=0.004). PCT is a fair marker in predicting NAFLD patients (AUC=0.75) with cutoff point 0.14 with sensitivity 84% and specificity 52%. While MPV is a poor marker in predicting NAFLD patients (AUC=0.67) with a cutoff point 8.75 with sensitivity 79% and specificity 33%. Also, PCT is an excellent marker in predicting cirrhotic patients (AUC=0.91) with cutoff point 0.185 with sensitivity 100% and specificity 67%. While MPV is a failed marker in predicting cirrhotic patients (AUC=0.30) with a cutoff point 8.20 with sensitivity 67% and specificity 23%. |