1.Hepatic Artery Resistive Index (HARi) and bard fibrosis score: Risk assessment of advanced liver fibrosis in patients with Non-Alcoholic Fatty Liver Disease (NAFLD).
Journal of the Philippine Medical Association 2021;100(1):14-28
INTRODUCTION:
Nonalcoholic fatty liver disease
(NAFLD) is a metabolic disorder with a wide clinical
continuum of liver diseases like focal hepatic
steatosis, steatohepatitis, advanced fibrosis, and
cirrhosis that usually progress in a rectilinear
fa sh ion. Through this course, NAFLD endure
certain hemodynamic changes in the hepatic
arterial blood flow. Thus, identification of patients
with advanced liver fibrosis is indispensable.
PURPOSE:
To determine the concordance of Hepatic
Artery Resistive Index (HARi) and Bard Fibrosis
Score in the assessment of advanced liver fibrosis
among patients with NAFLD and across its different
disease severity.
MATERIALS AND METHODS:
Observational descriptive
study design was used. 94 NAFLD patients without
history of excessive alcohol consumption were
invited and voluntarily participated in the research
investigation. Ultrasound scanning of the liver to
include color Doppler parameters (Peak systolic
volume [PSV], end diastolic volume [EDV] and
HAR/) and determination of BARD Fibrosis score
(Body mass index [BM/], fasting blood sugar [FBS]
and AST/ ALT ratio) were done. Different grading
across NAFLD was established.
RESULTS:
The HARi of NAFLD with BARD Fibrosis
scores of 1, 2, 3, and 4 has an average index of
0.84, 0.75 0.54 and 0.52, respectively. There is an
unwavering inverse correlation between HARi to
BARD Fibrosis scoring system (r=-0.84). Across the
different severity of NAFLD, grade Ill (severe) has
the lowest mean HARi at 0.53 followed by grade 11
(moderate) at 0.76 and grade I (mild) at 0.81.
Correspondingly, the BARD Fibrosis score showed
inverse ranking pattern across the different severity
of NAFLD. Grade I (mild) has the lowest BARD
fibrosis score followed by grade II (moderate) and
grade Ill (severe), which yielded having a mean
score of 1.00, 3.29 and 3.56, respectively.
CONCLUSION
The HARi has demonstrated a
significant negative correlation with advanced liver
fibrosis when correlated with BARD fibrosis score.
Thus, this study showed that the conventional
Doppler US with hepatic artery indices and
laboratory variables are helpful in detecting fibrous
tissue accumulation in the course of NAFLD.