Diagnostic Utility of Serum Ferritin in Identifying Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD): A Cross-Sectional Study Using National Health and Nutrition Examination Survey (NHANES-2017-2020) Data.

Unlabelled: Non-alcoholic fatty liver disease (NAFLD) is one of the major causes of chronic liver disease worldwide. There are conflicting reports on the association of serum ferritin levels and its utility in discriminating various stages of liver fibrosis in patients with NAFLD. This study is done to address the conflicts by analysing the National Health and Nutritional Examination Survey 2017-2020 (NHANES 2017-2020) data. The survey data was screened, and the eligible participants (n = 5901) were categorized based on the controlled attenuation parameter (CAP) obtained from Vibration Controlled and Transient Elastography (VCTE) scan into 2 groups, NAFLD (CAP ≥ 274 dB/m, n = 2528) and non-NAFLD (CAP < 274 dB/m, n = 3373). The NAFLD group had a significantly higher proportion of obese, diabetic, and metabolic syndrome participants. Serum ferritin levels were significantly higher in the NAFLD group, and the levels showed an upward trend from simple steatosis to significant fibrosis. Multivariate regression analysis showed that ferritin has a significant positive association with the median liver stiffness parameter (LSM), which is the index of liver fibrosis. Receiver operator characteristic curve (ROC) analysis showed that serum ferritin levels are a poor predictor of fibrosis (LSM > 8 kPA) in those with NAFLD (AUC = 0.59, Sensitivity = 53.5%, Specificity = 60.3%). To conclude, serum ferritin levels were positively associated and it trended upward as the disease progressed from simple steatosis to fibrosis in NAFLD. However, its diagnostic utility in discriminating liver fibrosis in patients with NAFLD is limited.

Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-023-01159-8.