Z Gastroenterol 2014; 52 - P_2_27
DOI: 10.1055/s-0033-1360914

To biopsy or not to biopsy: Evaluation of a large German cohort of patients with unclear hepatopathy and negative for viral hepatitis A, B, or C

JW Rey 1, V Doernberger 1, AP Barreiros 3, M Krupp 1, A Hoffman 2, R Kiesslich 2, M Müller-Schilling 3, PR Galle 1, A Jahn 4, A Teufel 3
  • 1University Medical Center Mainz, First Department of Internal Medicine, Mainz, Germany
  • 2St. Mary's Hospital Frankfurt, Department of Internal Medicine, Frankfurt, Germany
  • 3University Hospital Regensburg, Department of Internal Medicine I, Regensburg, Germany
  • 4University Medical Center Mainz, Institute for Medical Biostatistics, Epidemiology and Informatics, Mainz, Germany

Introduction:

Elevated laboratory liver values are common findings in patients with unclear hepatopathy. The decision of a whether a liver biopsy should be performed in these patients is mostly based on personal recommendations rather than well-established guidelines. Therefore, the aim of our retrospective single centre study was to determine if and which elevated laboratory liver values lead to the decision for a consecutive liver biopsy and if laboratory liver values may predict pathology findings.

Methods:

504 patients admitted for unclear hepatopathy to a university hospital outpatient clinic between 2007 and 2010 were analysed for all available laboratory results, clinical data, result of ultrasound and liver biopsies. Before inclusion in our study patients were tested for viral hepatitis A (HAV), B (HBV), and C (HCV) and excluded if positive since HAV rarely but HBV or HCV mostly require biopsy.

Results:

399 (79,2%) patients had the diagnosis of unclear hepatopathy, 17,9% (90) of cases the suspicion of NAFLD and 15 patients had other disorders. AST and GLDH values above the normal range significantly increased the risk to recommend a liver biopsy by 81% (OR with 95%-CI = 1.81 (1.21; 2.71), p = 0.004) and 159% (OR with 95%-CI = 2.59 (1.70; 3.93), p < 0.001), respectively. 32,1% (162) patients were liver biopsied after the first consultation. AST values above the normal correlated with fibrosis (63% vs. 40% for normal AST, p = 0,010). Elevated levels of Ferritin showed a significantly higher incidence of steatosis (48%, p < 0,001) and inflammation (87%, p = 0,004) in histologies from these biopsies.

Conclusion:

Our results indicated that elevated AST and GLDH were associated with a higher likelihood to recommend liver biopsy in patients admitted for unclear hepatopathy. However, in our study elevated values of AST and ferritin predicted a higher likelihood of steatosis, inflammation and fibrosis in liver biopsies. Thus, AST and Ferritin might be a better non-invasive predictor for liver pathology in patients with unclear hepatopathy. Further prospective studies are needed to confirm these results.