Liver fibrosis in overweight patients

Background & Aims: A common clinical issue is whether overweight patients w ith abnormal liver function test results should undergo liver biopsy. Altho ugh serious liver injury can occur, its prevalence and risk factors are not well known. Methods: Ninety-three consecutive patients with abnormal liver function tests (but without overt liver disease), body mass index (BMI) > 25 kg/m(2), and no alcoholic, viral, autoimmune, drug-induced, or genetic l iver disease were retrospectively studied. Clinical, biological, and histol ogical variables were tested for association with septal fibrosis or cirrho sis. Results: Septal fibrosis was present in 28 patients (30%) including ci rrhosis in 10 (11%), Age greater than or equal to 50 years (odds ratio [OR] , 14.1), BMI greater than or equal to 28 kg/m(2) (OR, 5.7), triglycerides g reater than or equal to 1.7 mmol/L (OR, 5), and alanine aminotransferase (A LT) greater than or equal to 2N (OR, 4.6) were independently associated wit h septal fibrosis, Among histological features, septal fibrosis was strongl y associated with necroinflammatory activity (OR, 44), A score combining ag e, BMI, triglycerides, and ALT had 100% negative predictive value for septa l fibrosis when scoring 0 or 1 (100% sensitivity for a specificity of 47%), Conclusions: Septal fibrosis occurs frequently in overweight patients with abnormal liver function tests. A clinicobiological score combining BMI, ag e, ALT, and triglycerides could improve selection of patients for liver bio psy.