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World J Hepatol. May 28, 2015; 7(9): 1192-1208
Published online May 28, 2015. doi: 10.4254/wjh.v7.i9.1192
Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries
Hilmar K Lückhoff, Frederik C Kruger, Maritha J Kotze
Hilmar K Lückhoff, Maritha J Kotze, Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Bellville 7530, Cape Town, Western Cape, South Africa
Frederik C Kruger, Gastroenterology Unit, Durbanville Medi-Clinic, Durbanville 7551, Cape Town, Western Cape, South Africa
Author contributions: Lückhoff HK conceptualized and wrote the first draft of the manuscript, in addition to revising and finalizing the corrected article proofs; Kruger FC and Kotze MJ contributed to critical reading and final editing of the revised manuscript.
Conflict-of-interest: Professor Kotze MJ is a director and shareholder of Gknowmix (Pty) Ltd. that has developed a database tool for research translation under the auspices of the Innovation Centre of the South African Medical Research Council. The other authors declared no conflict of interest and no writing assistance was obtained in the preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hilmar K Lückhoff, MBChB, HonsBSc, Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Bellville 7530, Cape Town, Western Cape, South Africa. hilmarklausl@gmail.com
Telephone: +27-21-9389324 Fax: +27-21-9389324
Received: August 28, 2014
Peer-review started: August 28, 2014
First decision: November 14, 2014
Revised: December 18, 2014
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: May 28, 2015
Processing time: 265 Days and 0.1 Hours
Abstract

Heterogeneity in clinical presentation, histological severity, prognosis and therapeutic outcomes characteristic of non-alcoholic fatty liver disease (NAFLD) necessitates the development of scientifically sound classification schemes to assist clinicians in stratifying patients into meaningful prognostic subgroups. The need for replacement of invasive liver biopsies as the standard method whereby NAFLD is diagnosed, graded and staged with biomarkers of histological severity injury led to the development of composite prognostic models as potentially viable surrogate alternatives. In the present article, we review existing scoring systems used to (1) confirm the presence of undiagnosed hepatosteatosis; (2) distinguish between simple steatosis and NASH; and (3) predict advanced hepatic fibrosis, with particular emphasis on the role of NAFLD as an independent cardio-metabolic risk factor. In addition, the incorporation of functional genomic markers and application of emerging imaging technologies are discussed as a means to improve the diagnostic accuracy and predictive performance of promising composite models found to be most appropriate for widespread clinical adoption.

Keywords: Liver biopsy; Genomics; Steatohepatitis; Non-invasive biomarkers; Histological severity; Non-alcoholic fatty liver disease

Core tip: Non-alcoholic fatty liver disease (NAFLD) remains largely underdiagnosed and undertreated in general practice. In view of the limitations inherent to liver biopsy and peripheral surrogate biomarkers used in the diagnosis and assessment of histological severity in NAFLD, a number of composite prognostic models have entered the clinical domain as potentially viable alternatives. Lifestyle-based intervention remains the cornerstone of treatment in patients with NAFLD. The widespread clinical adoption of composite diagnostic and predictive models could however prove useful in informing clinical and therapeutic decision making with the goal of adding value to patient care across the NAFLD spectrum.