الفهرس 
Chapter (I): Liver CirrhosisOnly 14 pages are availabe for public view
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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%.