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A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin‐18 for the diagnosis of non‐alcoholic steatohepatitis in morbidly obese patients
Author(s) -
Anty R.,
Iannelli A.,
Patouraux S.,
Bonnafous S.,
Lavallard V. J.,
SenniBuratti M.,
Ben Amor I.,
StacciniMyx A.,
SaintPaul M.C.,
Berthier F.,
Huet P.M.,
Le MarchandBrustel Y.,
Gugenheim J.,
Gual P.,
Tran A.
Publication year - 2010
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2010.04480.x
Subject(s) - steatohepatitis , medicine , fatty liver , metabolic syndrome , gastroenterology , alanine transaminase , steatosis , morbidly obese , cohort , cytokeratin , receiver operating characteristic , alanine aminotransferase , disease , obesity , weight loss , immunohistochemistry
Aliment Pharmacol Ther 2010; 32: 1315–1322 Summary Background Non‐invasive approaches are useful to differentiate simple steatosis from non‐alcoholic steatohepatitis (NASH) in obese and morbidly obese patients. Aim To develop a new scoring system to diagnose definitive NASH. Methods Preoperative clinical and biological data including serum caspase 3‐generated cytokeratin‐18 fragments (CK18) and surgical liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group ( n = 310) and validation group ( n = 154). Definitive NASH was defined according to Kleiner’s classification with a Non‐alcoholic fatty liver disease Activity Score (NAS) ≥5. Results Alanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome were independent predictors for discriminating patients with NAS ≥5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS ≥5. Whereas serum CK18 fragment alone had an area under the receiver operating characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training group and the validation group, respectively. Conclusion A simple and non‐invasive composite model (the Nice Model ) including metabolic syndrome, ALT and CK18 fragments is able to predict accurately a non‐alcoholic fatty liver disease activity score ≥5 in morbidly obese subjects.