Serum ferritin is an independent predictor of histologic severity and advanced fibrosis in patients with nonalcoholic fatty liver disease
Top Cited Papers
Open Access
- 27 September 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hepatology
- Vol. 55 (1), 77-85
- https://doi.org/10.1002/hep.24706
Abstract
Serum ferritin (SF) levels are commonly elevated in patients with nonalcoholic fatty liver disease (NAFLD) because of systemic inflammation, increased iron stores, or both. The aim of this study was to examine the relationship between elevated SF and NAFLD severity. Demographic, clinical, histologic, laboratory, and anthropometric data were analyzed in 628 adult patients with NAFLD (age, ≥18 years) with biopsy-proven NAFLD and an SF measurement within 6 months of their liver biopsy. A threshold SF >1.5 × upper limit of normal (ULN) (i.e., >300 ng/mL in women and >450 ng/mL in men) was significantly associated with male sex, elevated serum alanine aminotransferase, aspartate aminotransferase, iron, transferrin-iron saturation, iron stain grade, and decreased platelets (P < 0.01). Histologic features of NAFLD were more severe among patients with SF >1.5 × ULN, including steatosis, fibrosis, hepatocellular ballooning, and diagnosis of NASH (P < 0.026). On multiple regression analysis, SF >1.5 × ULN was independently associated with advanced hepatic fibrosis (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.62; P = 0.028) and increased NAFLD Activity Score (NAS) (OR, 1.99; 95% CI, 1.06-3.75; P = 0.033). Conclusions: A SF >1.5 × ULN is associated with hepatic iron deposition, a diagnosis of NASH, and worsened histologic activity and is an independent predictor of advanced hepatic fibrosis among patients with NAFLD. Furthermore, elevated SF is independently associated with higher NAS, even among patients without hepatic iron deposition. We conclude that SF is useful to identify NAFLD patients at risk for NASH and advanced fibrosis. (HEPATOLOGY 2012)This publication has 63 references indexed in Scilit:
- Serum ferritin concentration and transferrin saturation before liver transplantation predict decreased long-term recipient survivalJournal of Hepatology, 2011
- Serum ferritin levels are associated with vascular damage in patients with nonalcoholic fatty liver diseaseNutrition, Metabolism and Cardiovascular Diseases, 2011
- Effect of Vitamin E or Metformin for Treatment of Nonalcoholic Fatty Liver Disease in Children and AdolescentsJAMA, 2011
- Relationship between the pattern of hepatic iron deposition and histological severity in nonalcoholic fatty liver diseaseJournal of Hepatology, 2010
- Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver diseaseJournal of Hepatology, 2010
- Pioglitazone, Vitamin E, or Placebo for Nonalcoholic SteatohepatitisThe New England Journal of Medicine, 2010
- Ferritin functions as a proinflammatory cytokine via iron-independent protein kinase C zeta/nuclear factor kappaB-regulated signaling in rat hepatic stellate cellsJournal of Hepatology, 2008
- Hyperferritinemia Is Associated with Insulin Resistance and Fatty Liver in Patients without Iron OverloadPLOS ONE, 2008
- The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLDJournal of Hepatology, 2007
- Design and validation of a histological scoring system for nonalcoholic fatty liver diseaseJournal of Hepatology, 2005