Comparison of Different Liver Fibrosis Scores Following Sleeve Gastrectomy

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2025 Jan 8

PMID 39775103

Authors

Heilberger Alexander

Rauchfuss Falk

Settmacher Utz

Dondorf Felix

Ali Deeb Aladdin

Kissler Hermann

Schwenk Laura

Bruns Johanna

Ardelt Michael

Affiliations

Soon will be listed here.

Abstract

Purpose: The prevalence of obesity, along with that of its associated health conditions, including cardiovascular diseases, diabetes mellitus, and liver diseases, such as non-alcoholic fatty liver disease (NAFLD), is increasing annually. Bariatric surgery is indicated for the treatment of obesity if conservative treatment fails. While various liver fibrosis scores have been proposed for assessing liver function, they are typically used prior to bariatric surgery. This study aimed to determine whether fibrosis scores calculated from non-invasive parameters are effective in monitoring liver function after bariatric surgery.

Methods: This study analyzed data from 151 patients who underwent sleeve gastrectomy (SG) and were followed up at 3, 6, 9, 12, 24, and 36 months postoperatively. From the routinely collected parameters, liver fibrosis scores (APRI, Fib-4, BARD, Forns index [FORNS], Lok score [LOK], and NAFLD scores) were calculated retrospectively and compared to diabetes status % excess weight loss (%EWL) and % total weight loss (%TWL) over a 3-year follow-up period.

Results: After SG, APRI, FORNS, and NAFLD scores showed significant improvements, whereas Fib-4, BARD, and LOK scores did not improve. Similarly, body mass index, %EWL, %TWL, and diabetes status also improved significantly. Throughout the 3-year follow-up period, only the APRI and NAFLD scores showed significant improvement.

Conclusion: Only APRI and NAFLD scores changed significantly after SG. Thus, these two scores may be used to reflect and monitor liver function in patients who have undergone SG.

Citing Articles

Impact of Weight Loss on Metabolic Dysfunction Associated Steatohepatitis and Hepatic Fibrosis.

Takawy M, Abdelmalek M Curr Diab Rep. 2025; 25(1):23.

PMID: 39964660 DOI: 10.1007/s11892-025-01579-1.

References

Lavine J, Schwimmer J, Van Natta M, Molleston J, Murray K, Rosenthal P . Effect of vitamin E or metformin for treatment of nonalcoholic fatty liver disease in children and adolescents: the TONIC randomized controlled trial. JAMA. 2011; 305(16):1659-68. PMC: 3110082. DOI: 10.1001/jama.2011.520. View

Younossi Z . Non-alcoholic fatty liver disease - A global public health perspective. J Hepatol. 2018; 70(3):531-544. DOI: 10.1016/j.jhep.2018.10.033. View

Younossi Z, Anstee Q, Marietti M, Hardy T, Henry L, Eslam M . Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2017; 15(1):11-20. DOI: 10.1038/nrgastro.2017.109. View

Gungor N . Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol. 2014; 6(3):129-43. PMC: 4293641. DOI: 10.4274/Jcrpe.1471. View

Otgonsuren M, Stepanova M, Gerber L, Younossi Z . Anthropometric and clinical factors associated with mortality in subjects with nonalcoholic fatty liver disease. Dig Dis Sci. 2012; 58(4):1132-40. DOI: 10.1007/s10620-012-2446-3. View

Mummadi R, Kasturi K, Chennareddygari S, Sood G . Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008; 6(12):1396-402. DOI: 10.1016/j.cgh.2008.08.012. View

Souto K, Meinhardt N, Ramos M, Ulbrich-Kulkzynski J, Stein A, Damin D . Nonalcoholic fatty liver disease in patients with different baseline glucose status undergoing bariatric surgery: analysis of intraoperative liver biopsies and literature review. Surg Obes Relat Dis. 2017; 14(1):66-73. DOI: 10.1016/j.soard.2017.09.527. View

Koh Z, Salgaonkar H, Lee W, Kim G, Tan C, Cheng A . Improvement in Non-alcoholic Fatty Liver Disease Score Correlates with Weight Loss in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: a Two-Centre Study from an Asian Cohort. Obes Surg. 2018; 29(3):862-868. DOI: 10.1007/s11695-018-3581-5. View

Pai R, Kleiner D, Hart J, Adeyi O, Clouston A, Behling C . Standardising the interpretation of liver biopsies in non-alcoholic fatty liver disease clinical trials. Aliment Pharmacol Ther. 2019; 50(10):1100-1111. PMC: 6817398. DOI: 10.1111/apt.15503. View

10.

Wai C, Greenson J, Fontana R, Kalbfleisch J, Marrero J, Conjeevaram H . A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003; 38(2):518-26. DOI: 10.1053/jhep.2003.50346. View

11.

Hanley J, McNeil B . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982; 143(1):29-36. DOI: 10.1148/radiology.143.1.7063747. View

12.

Cheng C, Chu C, Chen H, Lin I, Wu C, Lee Y . Subgroup analysis of the predictive ability of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) for assessing hepatic fibrosis among patients with chronic hepatitis C. J Microbiol Immunol Infect. 2019; 53(4):542-549. DOI: 10.1016/j.jmii.2019.09.002. View

13.

Cichoz-Lach H, Celinski K, Prozorow-Krol B, Swatek J, Slomka M, Lach T . The BARD score and the NAFLD fibrosis score in the assessment of advanced liver fibrosis in nonalcoholic fatty liver disease. Med Sci Monit. 2012; 18(12):CR735-40. PMC: 3560810. DOI: 10.12659/msm.883601. View

14.

Forns X, Ampurdanes S, Llovet J, Aponte J, Quinto L, Martinez-Bauer E . Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002; 36(4 Pt 1):986-92. DOI: 10.1053/jhep.2002.36128. View

15.

Lok A, Ghany M, Goodman Z, Wright E, Everson G, Sterling R . Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort. Hepatology. 2005; 42(2):282-92. DOI: 10.1002/hep.20772. View

16.

Sun L, Wang Q, Liu M, Xu G, Yin H, Wang D . Albumin binding function is a novel biomarker for early liver damage and disease progression in non-alcoholic fatty liver disease. Endocrine. 2020; 69(2):294-302. DOI: 10.1007/s12020-020-02319-z. View

17.

Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cardenas E, Sanchez-Avila F, Vargas-Vorackova F . AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol. 2008; 7(4):350-7. View

18.

Newsome P, Cramb R, Davison S, Dillon J, Foulerton M, Godfrey E . Guidelines on the management of abnormal liver blood tests. Gut. 2017; 67(1):6-19. PMC: 5754852. DOI: 10.1136/gutjnl-2017-314924. View

19.

Dyson J, Anstee Q, McPherson S . Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol. 2014; 5(3):211-218. PMC: 4078666. DOI: 10.1136/flgastro-2013-100403. View

20.

Ionut V, Bergman R . Mechanisms responsible for excess weight loss after bariatric surgery. J Diabetes Sci Technol. 2011; 5(5):1263-82. PMC: 3208891. DOI: 10.1177/193229681100500536. View