Frequency of Liver Fibrosis by Non Invasive Marker in Patients with Non-Alcohol Fatty Liver Diseases

Frequency of Liver Fibrosis by Non-Invasive Marker


  • Ghulam Fatima Liaquat University Hospital, Hyderabad, Pakistan
  • Kaneez Zainab Rabail Jinnah Post Graduate Medical Centre, Karachi, Pakistan
  • Mona Humaira Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
  • Afsana Khaskheli Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
  • Benazir Bughio Liaquat University Hospital, Hyderabad, Pakistan
  • Kashaf Nida Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan



Nonalcoholic Fatty Liver Disease, Liver Fibrosis, Insulin Resistance


Nonalcoholic fatty liver disease (NAFLD) is one of the most important causes of liver disease. NAFLD is commonly associated with obesity, insulin resistance and other metabolic abnormalities such as hypertriglyceridemia and hyperuricemia.  Patients with NAFLD can be properly rationalized and with early exploration and management of fatty liver the progression and complications of NAFLD in relation to liver fibrosis can be reduced on priority basis because the APRI is noninvasive and a simple calculation of two laboratorial variables. Objective: To determine the frequency of liver fibrosis by non-invasive marker in patients with non-alcohol fatty liver disease. Methods: This cross-sectional descriptive study was conducted upon 164 patients with NAFLD, presented at Department of Medicine, Liaquat University Hospital, Hyderabad. All the patients with NAFLD were evaluated and explored for liver fibrosis through APRI by taking 2cc venous blood sample in a sterilized syringe by principal investigator and send to laboratory for analysis to get the AST and platelet count. An APRI score greater than 0.7 was set cut off for significant hepatic fibrosis. The data were collected on pre-designed proforma.  The study lasted 6 months from 26th February 2020 to 31st August 2020. Results: The mean age of the patients was 48.15±11.13 years. Frequency of liver fibrosis by non-invasive marker in patients with non-alcohol fatty liver disease was 10.98% (18/164).  The mean APRI score was found to be 1.8±0.6. Conclusions: It was concluded that APRI is noninvasive and a simple calculation of two laboratory variables and can easily be used at the bedside or in an outpatient setting to assess the liver fibrosis. In this way, the management of NAFLD can be improved.  


Townsend SA and Newsome PN. Non-alcoholic fatty liver disease in 2016. British Medical Bulletin. 2016 Sep; 119(1): 143. doi: 10.1093/bmb/ldw031.

Yki-Järvinen H. Diagnosis of non-alcoholic fatty liver disease (NAFLD). Diabetologia. 2016 Jun; 59(6): 1104-11. doi: 10.1007/s00125-016-3944-1.

Hardy T, Oakley F, Anstee QM, Day CP. Nonalcoholic fatty liver disease: pathogenesis and disease spectrum. Annual Review of Pathology: Mechanisms of Disease. 2016 May; 11: 451-96. doi: 10.1146/annurev-pathol-012615-044224.

Leoni S, Tovoli F, Napoli L, Serio I, Ferri S, Bolondi L. Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis. World Journal of Gastroenterology. 2018 Aug; 24(30): 3361. doi: 10.3748/wjg.v24.i30.3361.

Dassanayake AS. Nonalcoholic fatty liver disease: identifying the disease burden in Sri Lanka. Euroasian Journal of Hepato-Gastroenterology. 2018 Jan; 8(1): 69. doi: 10.5005/jp-journals-10018-1263.

Cho HC. Prevalence and factors associated with nonalcoholic fatty liver disease in a nonobese Korean population. Gut and Liver. 2016 Jan; 10(1): 117. doi: 10.5009/gnl14444.

Ghani RA, Saqlain M, Zafar MM, Jabeen S, Naqvi SM, Raja GK. Identification of metabolic risk phenotypes predisposing to non-alcoholic fatty liver disease in a Pakistani Cohort. Pakistan Journal of Medical Sciences. 2017 Jan; 33(1): 121. doi: 10.12669/pjms.331.11445.

Benedict M and Zhang X. Non-alcoholic fatty liver disease: An expanded review. World Journal of Hepatology. 2017 Jun; 9(16): 715. doi: 10.4254/wjh.v9.i16.715.

Pappachan JM, Babu S, Krishnan B, Ravindran NC. Non-alcoholic fatty liver disease: a clinical update. Journal of Clinical and Translational Hepatology. 2017 Dec; 5(4): 384. doi: 10.14218/JCTH.2017.00013.

Hassan K, Bhalla V, El Regal ME, A-Kader HH. Nonalcoholic fatty liver disease: a comprehensive review of a growing epidemic. World Journal of Gastroenterology: WJG. 2014 Sep; 20(34): 12082. doi: 10.3748/wjg.v20.i34.12082.

Guha IN, Parkes J, Roderick P, Chattopadhyay D, Cross R, Harris S, et al. Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European Liver Fibrosis Panel and exploring simple markers. Hepatology. 2008 Feb; 47(2): 455-60. doi: 10.1002/hep.21984.

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003 Aug; 38(2): 518-26. doi: 10.1053/jhep.2003.50346.

Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults. Alimentary Pharmacology & Therapeutics. 2011 Aug; 34(3): 274-85. doi: 10.1111/j.1365-2036.2011.04724.x.

Tai FW, Syn WK, Alazawi W. Practical approach to non‐alcoholic fatty liver disease in patients with diabetes. Diabetic Medicine. 2015 Sep; 32(9): 1121-33. doi: 10.1111/dme.12725.

Noguchi H, Tazawa Y, Nishinomiya F, Takada G. The relationship between serum transaminase activities and fatty liver in children with simple obesity. Pediatrics International. 1995 Oct; 37(5): 621-5. doi: 10.1111/j.1442-200X.1995.tb03389.x.

Charatcharoenwitthaya P, Lindor KD, Angulo P. The spontaneous course of liver enzymes and its correlation in nonalcoholic fatty liver disease. Digestive Diseases and Sciences. 2012 Jul; 57: 1925-31. doi: 10.1007/s10620-012-2098-3.

Levene AP and Goldin RD. The epidemiology, pathogenesis and histopathology of fatty liver disease. Histopathology. 2012 Aug; 61(2): 141-52. doi: 10.1111/j.1365-2559.2011.04145.x.

McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. Journal of Hepatology. 2015 May; 62(5): 1148-55. doi: 10.1016/j.jhep.2014.11.034.

Angulo P. Long-Term Mortality in Nafld. is Liver Histology of Any Prognostic Significance? Hepatology (Baltimore, Md.). 2010 Feb; 51(2): 373. doi: 10.1002/hep.23521.

Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015 Aug; 149(2): 389-97. doi: 10.1053/j.gastro.2015.04.043.

Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012 Jun; 55(6): 2005-23. doi: 10.1002/hep.25762.

Parkes J, Roderick P, Harris S, Day C, Mutimer D, Collier J, et al. Enhanced liver fibrosis test can predict clinical outcomes in patients with chronic liver disease. Gut. 2010 Sep; 59(9): 1245-51. doi: 10.1136/gut.2009.203166.

Kim NH, Kim JH, Kim YJ, Yoo HJ, Kim HY, Seo JA, et al. Clinical and metabolic factors associated with development and regression of nonalcoholic fatty liver disease in nonobese subjects. Liver International. 2014 Apr; 34(4): 604-11. doi: 10.1111/liv.12454.

Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011 Jan; 140(1): 124-31. doi: 10.1053/j.gastro.2010.09.038.

Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL, et al. How common is non‐alcoholic fatty liver disease in the Asia–Pacific region and are there local differences? Journal of Gastroenterology and Hepatology. 2007 Jun; 22(6): 788-93. doi: 10.1111/j.1440-1746.2007.05042.x.

Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clinical Gastroenterology and Hepatology. 2011 Jun; 9(6): 524-30. doi: 10.1016/j.cgh.2011.03.020.




How to Cite

Fatima, G. ., Zainab Rabail, K. ., Humaira, M. ., Khaskheli, A. ., Bughio, B. ., & Nida, K. . (2023). Frequency of Liver Fibrosis by Non Invasive Marker in Patients with Non-Alcohol Fatty Liver Diseases: Frequency of Liver Fibrosis by Non-Invasive Marker. Pakistan Journal of Health Sciences, 4(02), 99–102.



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