Exploring the severity and risk factors of non-alcoholic fatty liver disease based on the SAF scoring system

Xin Xin Li Yu Shi Wang Yu Zi Zhang Wen Deng Yaqin Zhang Weihua Cao Xin Wei Xuan Zi Gao Mei Lin Yao Lie Shuo Wang Yao Xie ^* Wei Yi Hui Ming Li ^*

• Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University. Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China

Objective: The SAF (Steatosis, Activity, Fibrosis) score, a histological scoring system proposed by the European Group for the Study of Fatty Liver, is used to evaluate liver biopsy samples in non-alcoholic fatty liver disease (NAFLD). Based on pathological results and SAF scores, NAFLD patients were categorized into mild, moderate, and severe groups. We compared the differences among these groups and identified risk factors influencing lesion severity.Method: We selected data from 539 NAFLD patients who underwent percutaneous liver biopsy confirmation at the Beijing Ditan Hospital from January 2018 to December 2022. All biopsies were graded according to the SAF scoring system, and the severity of the disease was classified as mild, moderate, and severe. The differences in gender, age, BMI, history of diabetes, history of hypertension, AST, ALT, serum cholesterol level and other aspects of patients with NAFLD of different severity were compared, and the risk factors affecting the severity of their lesions were further explored.Result: A total of 539 patients were enrolled in this study, aged from 6 to 79 years old, including 325 males and 214 females with an average age of 39 ± 13 years. They were divided into mild NAFLD group (162 cases), moderate NAFLD group (210 cases), and severe NAFLD group (167 cases). The results showed significant differences among the three groups in terms of age composition, high calorie diet, family history of hypertension, ALT, AST, GGT, total bile acids, cholinesterase, glycosylated albumin, blood glucose, uric acid, type III procollagen, serum human laminin, liver hardness, and hepatic steatosis.Conclusion: BMI, uric acid, AST, type III procollagen, liver hardness, and liver steatosis indicators play important roles in the progression of NAFLD and are risk factors for high pathological SAF scores in NAFLD patients.