Are there predictive factors of severe liver fibrosis in morbidly obese patients with non-alcoholic steatohepatitis?

Background: Non-alcoholic steatohepatitis (NASH) is a clinicopathological e ntity characterized by the presence of steatosis and lobular and/or portal inflammation with or without fibrosis, Patients with non-alcoholic fatty li ver and fibrosis on liver biopsy have increased liver-related deaths. Methods: 181 wedge liver biopsies, taken at the time of bariatric surgery f rom patients with a mean body mass index (BMI) of 47, were studied. In all cases, the liver biopsy was performed without knowledge of the patient's cl inical and biochemical data, which were then examined with univariate and m ultivariate analysis. Results: Diagnosis of NASH was established in 105 patients (91%); 74 patien ts (70%) showed mild steatosis, 20 (19%) had moderate inflammation and fibr osis, and 11 (10%) had steatosis with severe fibrosis, None of the liver bi opsies showed cirrhosis, Age was the only independent predictor of moderate and severe fibrosis (p=0.001), Conclusions: Since only age was a predictor of moderate or severe fibrosis, and no clinical or biochemical abnormalities detected slowly progressive h epatic fibrosis, liver biopsy is the only means of detecting progression to more advanced liver disease in a NASH patient.