Prevalence and risk factors of liver fibrosis in patients with metabolic-associated fatty liver disease undergoing bariatric surgery

Aim of the study: Liver fibrosis affects progression of fatty liver. Epidemiological data about fibrosis in overweight/obese Egyptian patients undergoing bariatric surgery are limited. We aimed to assess hepatic steatosis and fibrosis in patients with metabolic associated fatty liver disease (MAFLD) before bariatric surgery via noninvasive tools and liver biopsy. Material and methods: A cross-sectional study of overweight/obese MAFLD patients undergoing bariatric surgery in the Hepatogastroenterology Hospital was performed. For all recruited cases, the history was taken and clinical examination, laboratory testing, intra-operative laparoscopic liver biopsies and histopathological evaluation were conducted. Fibrosis-4 (FIB-4), NAFLD Fibrosis Score (NFS), and AST to platelet ratio (APRI) were calculated. Results: The final number of patients with significant fibrosis was 85; of these, 24/85 (28.2%) met the MAFLD criteria (F2), 11/85 (12.9%) had advanced fibrosis (F3-F4), and 50/85 (58.8%) had no significant fibrosis (F0-F1). Fibrosis was significantly higher in the elderly, smokers, and those with diabetes, hypertension, or chronic hepatitis C virus (HCV) infection. Degree of fibrosis was positively correlated with body mass index (BMI), waistserum uric acid, fasting blood sugar (FBS), and HbA1c levels, and negatively with platelet level. Regression analysis indicated that smoking, elevated BMI, presence of diabetes and hypertension, decreased platelet level and elevated serum uric acid are predictors of significant fibrosis. Non-invasive models, such as FIB-4, NFS, and APRI provided greater accuracy for predicting significant fibrosis. Conclusions: Significant fibrosis (F >= 2) was detected in > 1/3 of patients with MAFLD undergoing bariatric surgery. Presence of smoking, diabetes, hypertension, high WHR, elevated serum uric acid, advanced age, and low platelet level are risk factors for significant fibrosis (F >= 2). Noninvasive models, FIB-4, NFS, and APRI can be used to identify significant liver fibrosis in bariatric surgery patients.