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Biomarkers inaccurate in measuring steatosis among patients with NAFLD

Multiple biomarkers were unable to accurately and effectively measure the various levels of steatosis among patients with nonalcoholic fatty liver disease, according to study data.

“Several steatosis biomarkers are available with limited independent validation,” the researchers wrote. “(We sought) to determine the diagnostic value and limitations of several steatosis biomarkers using liver biopsy as a reference standard in a large cohort of patients with suspected NAFLD.”

Researchers analyzed laboratory and medical data from 324 patients with NAFLD who underwent liver biopsy to determine whether the following biomarkers were effective in measuring steatosis: fatty liver index (FLI), NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index (HIS), visceral adiposity index (VAI) and triglyceride-glucose index (TyG). The mean age of the patients was 52.6 ± 11.43 years and 64% were male.

Overall, 5% of patients did not have steatosis, 39% had mild, 30% moderate and 27% severe. All five biomarkers were effective and accurate in detecting steatosois; area under the receiver operating curve (AUROC) for FLI was 0.83, 0.8 for NAFLD-LFS, 0.81 for HIS, 0.92 for VAI and 0.9 for TyG. However, all five biomarkers were unable to quantify and distinguish between the various levels of steatosis, more specifically moderate and severe levels, and had low AUROCs for predicting moderate to severe steatosis prevalence. None of the biomarkers were effective or accurate in diagnosing steatosis through ultrasound.

Using the homeostasis model assessment of estimated insulin resistance (HOMA-IR) index, biomarkers were positively correlated with insulin resistance independent of the histological grades of steatosis. However, the strength of the correlation was between weak and moderate. NAFLD-LFS showed the strongest correlation with HOMA-IR (Pearson’s coefficient, 0.859).  

“We show that all five surrogate biomarkers for steatosis are able to discriminate between the absence and the presence of steatosis with an overall good diagnostic performance,” the researchers concluded. “However, these biomarker panels are insufficiently accurate for the quantification of steatosis, and thus their value for monitoring changes in steatosis induced by pharmacological agents, diet and lifestyle measures or simply the natural course of the disease, will probably be limited.”

Disclosure: The study was funded by the European Community’s Seventh Framework Program.