LINASH: A smartphone-based Lyfas IOT platform for non-invasive mass screening and staging of NASH

Author(s): Subhagata Chattopadhyay* & Rupam Das

Objective: NASH is a progressive stage of Non-alcoholic Fatty Liver Disease (NAFLD) and is characterized by liver fibrosis. NAFLD is a silent tsunami of the cardiometabolic syndrome (CMS). Insulin resistance (IR) is the hallmark feature of CMS that Lyfas, a smartphone-based m-health instrument, captures non-invasively by measuring the low-by-high frequency ratio (LF/HF), derived from a short heart rate variability (HRV). The paper proposes an end-to-end Lyfas IoT Non-alcoholic Steatohepatisis (NASH) screening and staging platform (LINASH).

Methods: An online screening platform for NAFLD and NASH using Chronic Liver Disease Questionnaire (CLDQ) and developing recommendation engines for grading and management of NASH. Suspicious cases took the Lyfas tests thrice daily for a month. An average LF/HF score is captured, based on which LINASH recommends a USG elastogram to examine the liver stiffness, which, if present, further recommends blood tests and FIB-4 scoring to decide on the liver biopsy, else they are monitored. Statistical correlations and reliability of LF/HF with blood biomarkers, physical parameters, and FIB-4 are also checked. An IoT-enabled platform for generating health awareness, screening, and prediction of NASH. A total of 86 NAFLD and 38 NASH-affected subjects participated in the LINASH trial. Another 106 healthy controls were also recruited.

Results: LF/HF has a good agreement with the FIB-4 method. LF/HF also has a good correlation with ALT across the population, except for the healthy and NASH males.

Conclusion: LF/HF is a significant COB of IR and has a good correlation with ALT. It can be reliably used for screening NAFLD and possibilities of NASH, integrated with USG elastography and then FIB-4 for staging. LINASH is a fast, personalized, non-invasive, and ubiquitous smartphone-based platform that can be used for initial epidemiological surveillance on a mass scale. An inadvertent sampling bias while excluding alcoholic steatohepatitis.