EVALUATION OF LIVER FIBROTIC FORMATION IN PATIENTS WITH CHRONIC PANCREATITIS USING NON-INVASIVE AST/ALT INDEX, APRI INDEX, FIB4 SCORE

Abstract

Introduction: Increasing world population, population migration, changes in alcohol use, tobacco use, diet, increasing obesity and metabolic syndrome among the younger generation adds to the epidemiology of chronic pancreatitis. Metabolicassociated fatty liver disease (МAFLD) is one of the chronic metabolic diseases that most often develops against a background of type 2 diabetes mellitus (DM), obesity and arterial hypertension. The development of MAJBP in patients with chronic pancreatitis is provoked by unbalanced diet, stress, alcohol consumption and smoking, as well as the presence of overweight or obesity in the patient and other environmental and lifestyle factors contribute to the progression of МAFLD. Objective: To study the diagnostic value of non-invasive indices AST/ALT, APRI index (Aminotransferase to platelet ratio index) and Fibrosis-4 Score (FIB-4 Score) Index in patients with chronic pancreatitis for assessment of liver fibrosis. Materials and methods: Our study was a single case retrospective cross-sectional study. It included male and female patients aged 18 to 75 years with a confirmed diagnosis of chronic pancreatitis, who received inpatient treatment in the Department of Gastroenterology of the University Hospital of ‘Semey Medical University’ during the period 01.01.2021 to 31.12.2023. Patients with malignant neoplasms, pregnancy, lactation were excluded from the study. Non-invasive indices - AST/ALT, APRI index (Aminotransferase to platelet ratio index) and Fibrosis-4 Score (FIB-4 Score) Index were used to assess fibrosis formation in the liver. Results: We selected 331 case histories of patients with chronic pancreatitis, including 218 women and 113 men. When studying the mean values of AST/ALT ratio, we found a difference by sex (p=0.001), BMI (p=0.04). Higher mean AST/ALT values were found more often in men compared to women. High AST/ALT values were more frequent in overweight and obese patients. The difference in mean APRI index values was found only in BMI groups (p=0.03). High APRI index values were also more common in overweight and obesity. When we studied the distribution of risk factors for liver fibrosis according to AST/ALT ratio, the chance of developing liver fibrosis was 1.82 times higher in men compared to women (p=0.001). Also according to AST/ALT ratio data the chance of liver fibrosis development was increased in case of overweight and obesity (p=0.04). Whereas, the mean values of FIB-4 Score differed by gender (p=0.02) and in patients with and without type 2 DM (p=0.006). Conclusions: Thus, the application in practice of diagnostic non-invasive indices AST/ALT, APRI index, FIB-4 Score in patients with chronic pancreatitis may help for early diagnosis and evaluation of liver fibrosis.