Diagnostic value of nitrogen metabolism disorders in non-alcoholic fatty liver disease in comorbid patients with metabolic syndrome and stratification of disease stages

The aim of the study is to determine the significance of hyperammonemia for the diagnosis of non-alcoholic fatty liver disease (NAFLD) in patients with metabolically associated comorbid pathology. Materials and Methods. A single-stage cohort randomized study was conducted to examine NAFLD in patients with metabolically associated pathology type 2 diabetes, obesity, hypertension, coronary artery disease, and dyslipidemia. The study included 96 patients, who were divided into 3 groups: patients with steatotic liver disease (n=33), patients with non-alcoholic steatohepatitis (n=47) and patients with newly diagnosed liver cirrhosis (n=16). For NAFLD diagnosis, non-invasive methods were also applied (APRI, FIB4, NAFLD fibrosis score). To diagnose hepatocellular insufficiency, the authors evaluated ammonia level in capillary blood. Statistical processing was carried out by parametric and nonparametric methods, correlation and cluster analysis (Statistica 10.0). We also calculated odds ratio. Results. Metabolic syndrome in patients aged 64.2±0.85 (64.9 % females and 35.1 % males, Charleson comorbidity index 4.57±0.12) was represented by type 2 diabetes (100 %), insulin-treated diabetes (2/3 of patients), hypertension (1/3 of patients, stage 3 of NAFLD), obesity (87.5 %), coronary heart disease (90.6 %), steatotic liver disease (34.4 %), non-alcoholic steatohepatitis (49 %) and asymptomatic liver cirrhosis (16,6 %). According to NFS results, stage F3-F4 fibrosis was diagnosed in 52.1 % of patients, F2 fibrosis in 47.9 %; hyperammonemia was found in 91.7 % (up to 111.1±4.86 (101.3-120.7) jmol/l). Hyperammonemia developed from steatosis to non-alcoholic steatohepatitis and liver cirrhosis and correlated with the stage of liver fibrosis, hepatitis activity, and metabolic syndrome key criteria. NFS calculator and hyperammonemia diagnosis made it possible to stratify the stages of non-alcoholic fatty liver disease.