Findings on Liver Biopsy in Patients with Abnormal Liver Function Tests of Unknown Etiology: 266

Purpose: Abnormal liver function tests (LFTS) is a commonly encountered clinical problem. Most times they are found incidentally on routine blood work in asymptomatic patients. Many of these patients may have non-alcoholic fatty liver disease (NAFLD). NAFLD is a spectrum of disorders that ranges from simple steatosis to steatohepatitis to advanced fibrosis and cirrhosis. Definitive diagnosis is made with biopsy. Accordingly our aim was to evaluate the biopsy results of patients with abnormal LFTS. Methods: We performed a retrospective chart review of all patients who had a liver biopsy done at our institution between 2008 and March 2010. All had been referred to the liver clinic. The evaluation had been negative and included medication use, ethanol use, ultrasound findings, fasting lipid profile, hepatitis B and C serologies, iron panel, ferritin, ceruloplasmin, alpha one antitrypsin, anti-nuclear antibody, anti-smooth muscle antibody and anti-mitochondrial antibody. BMI and ethnicity for these patients was also recorded. Results: A total of 190 liver biopsies were conducted during this time period. Thirty one patients were found to have abnormal transaminases without a source despite extensive workup. Of these, 14 were males, and 17 were females. The Batts and Ludwig system for evaluating histology in chronic liver disease was used. Nine patients had no fibrosis on biopsy. This included those with minimal inflammation, simple steatosis, and normal liver histology. Three patients had cirrhosis. The table below provides further detail into the age (mean), gender, BMI (mean), ALT (mean), and the average triglyceride (TG) level of patients at each stage. Conclusion: In our series two patients were found to be histologically normal, while 93% (29/31) were found to have NAFLD. 77% of patients were found to have inflammation and or fibrosis. There did not appear to be an association between the ALT and the amount of fibrosis, whereas older patients with elevated BMI's seemed to have more fibrosis. Increasing fibrosis was also seen with higher triglyceride levels. Of note 6 of the 7 patients with advanced fibrosis were women. Our data provides some insight into making the distinction between simple steatosis and more advanced disease by correlating clinical and histological criteria.Table