Serum TGF-beta, serum mmp-1, and HOMA-IR as non-invasive predictors of fibrosis in Egyptian patients with NAFLD

Non-alcoholic fatty liver disease [NAFLD] is an increasingly prevalent cause of chronic liver disease worldwide. A number of these patients progress to nonalcoholic steatohepatitis [NASH] which carries significant morbidity and mortality. The aim of this study is to evaluate the diagnostic value of serum levels of transforming growth factor beta-1 [TGF- beta 1] matrix metalloproteinase-1 [MMP-1], and insulin resistance as predictors of fibrosis in Egyptian NAFLD patients. Fifty patients with NAFLD and different stages of fibrosis were studied. Serum levels of TGF- beta 1, MMP-1, and fasting serum insulin were measured; calculation of the homeostasis model assessment for insulin resistance [HOMA-IR] was done. TGF- beta 1 gives a sensitivity of 100% and specificity of 94.4% for stage 1 fibrosis, 100% and 93.9%, respectively, for stage 2 fibrosis, and 97.7% and 100%, respectively, for stage 3 fibrosis. MMP-1 showed sensitivity and specificity of 88% and 81.8%, respectively, for stage 2 fibrosis, 90.9% and 55.56%, respectively, for stage 3 fibrosis, but it is of no diagnostic value in stage 1 fibrosis. Serum TGF- beta 1, MMP-1, and insulin resistance [HOMA-IR] proved to be potentially useful noninvasive markers in predicting fibrosis in NASH patients.

value of fibroscan as a non-invasive predictor of large esophageal varices in cirrhotic patients

Periodic endoscopic screening for esophageal varices [EV] is recommended in patients with cirrhosis, but might be limited to a subgroup of patients if a simple non-invasive test was available to select those at risk of bleeding. To assess the value of Fibroscan as a simple non-invasive test for selecting patients with cirrhosis at risk of bearing large EV. In 50 patients with cirrhosis, we studied the relation between the presence and grading of esophageal varices as assessed by endoscopy and liver stiffness measurement by Fibroscan, a non-invasive parameter related to liver fibrosis. Receiver operator characteristic curve was used to identify the best cut-off point for liver stiffness measurement. The identified best cut-off point for liver stiffness measurement [LSM] was 20.90 with sensitivity 71.4% and specificity 66.6% for prediction of the presence of esophageal varices while for prediction of the presence of large varices, the best cut off value was 26.00 with sensitivity 80% and specificity 60%. LSM is of higher diagnostic value in predicting the presence of large esophageal varices in patients with cirrhosis. and may help to select patients for endoscopic screening