Laboratory parameters of 1st order – obligatory laboratory tests.
- Small blood count (alcohol consumption: MCV ↑).
- Fasting glucose (fasting blood glucose, fasting plasma glucose; preprandial plasma glucose; venous).
- HbA1c (long-term blood glucose value)
- Ferritin (iron stores) [ferritin ↑, in 29-50% of cases].
- Triglycerides
- Total cholesterol and LDL/HDL ratio
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT) [↑][non-alcoholicfatty liver: ALT > AST], glutamate dehydrogenase (GLDH), gamma-glutamyl transferase (γ-GT, gamma-GT; GGT), alkaline phosphatase [AP ↑], bilirubin [GOT/GPT quotient:
- <1 (GOT, GPT, elevated 2-3-fold): mild liver injury (common in viral hepatitis and nonalcoholic fatty liver hepatitis); γ-GT (only mildly elevated in nonalcoholic fatty liver hepatitis); bilirubin (usually normal).
- > 1: severe liver injury (typical of alcoholic liver injury and cirrhosis); γ-GT (severely elevated in alcoholic fatty liver hepatitis)]
Note: Patients with non-alcoholic fatty liver (NAFLD) have predominantly normative transaminases.Normal values for transaminases do not exclude liver cirrhosis.Note: In children and adolescents with a body mass index (BMI) above the 97th percentile according to Kromeyer-Hauschild, the level of alanine aminotransferase (ALT, GPT) should be determined, among others.
- CDT (Carbohydrate Deficient Transferrin) – indicator of alcohol consumption [increase with daily alcohol consumption of more than circa 60-70 g over circa two weeks].
Laboratory parameters 2nd order – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification.
- Fetuin-A – new fatty liver marker, which is also a marker of insulin resistance; Fetuin-A inhibits adiponectin and increases the level of tumor necrosis factor-alpha (TNFα), which has an inflammatory (pro-inflammatory) effect on blood vessels.
- Antithrombin III (AT-III) – clotting factor.
- Albumin in serum – important protein (protein).
- Ammonia – metabolic product in the body
- Hepatitis markers – laboratory parameters that indicate liver inflammation, such as:
- HCV antibodies in the presence of hepatitis C or HCV screening in the presence of steatosis.
- HBs-Ag, anti-HBc, anti-HBc IgM in the presence of hepatitis B.
- Autoantibodies – antibodies directed against structures of the patient’s own body – such as AMA (antimitochondrial antibodies) or pANCA (perinuclear anti-neutrophil cytoplasmic antibody).
- Anti-transglutaminase-AK-IgA,-IgG – if celiac disease (gluten-induced enteropathy) is suspected.
- Alpha-fetoprotein – in suspected hepatocellular carcinoma (liver cancer).
- Β-Glucocerebrosidase or detection of mutations in the GBA gene by PCR and subsequent sequencing – exclusion Gaucher disease (autosomal recessive lysosomal storage disease (LSD)).
- Coeruloplasmin, copper excretion in 24 h urine (quantitative) – exclusion Wilson disease.
- Lysosomal acid lipase – exclusion of lysosomal acid lipase deficiency (LAL-D; autosomal recessive lysosomal storage disease (LSD)).
- Serum ferritin – if hemochromatosis (iron storage disease) is suspected.
- HIV test
- TSH
Fatty Liver Index (FLI; fatty liver index)
The “Fatty Liver Index” is a suitable screening method to calculate the probability of fatty liver. It consists of an algorithm of triglycerides (mg/dL), BMI (kg/m²), gamma-GT (U/L), and abdominal circumference (cm). The FLI can vary between 0 and 100. An FLI < 30 (negative likelihood ratio = 0.2) excludes fatty liver with high probability, and an FLI > 60 (positive likelihood ratio = 4.3) indicates fatty liver.
NAFLD fibrosis score (NFS)
To detect or exclude prognostically unfavorable advanced liver fibrosis, the NAFLD fibrosis score (NFS) is useful.It consists of an algorithm of age, BMI, impaired fasting glucose (IGF)/diabetes (yes/no), aspartate aminotransferase (AST, GOT), alanine aminotransferase (ALT, GPT), platelet count, and albumin.
