Abstract
BackgroundNonalcoholic fatty liver disease (NAFLD) is one of the critical public health problems in China. The full spectrum of the disease ranges from simple steatosis and nonalcoholic steatohepatitis (NASH) to cirrhosis and hepatocellular carcinoma(HCC). The infiltration of inflammatory cells characterizes NASH. This characteristic contributes to the progression of hepatitis, fibrosis, cirrhosis, and HCC. Therefore, distinguishing NASH from NAFLD is crucial.Objective and MethodsNinety-five patients with NAFLD, 44 with NASH, and 51 with non-NASH were included in the study to develop a new scoring system for differentiating NASH from NAFLD. Data on clinical and biological characteristics, as well as blood information, were obtained. Cytokeratin-18 (CK-18) fragments levels were measured using an enzyme-linked immunosorbant assay.ResultsSeveral indexes show significant differences between the two groups, which include body mass index (BMI), waist-on-hip ratio (WHR), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), platelets, uric acid (UA), hs-C-reactive protein (hs-CRP), triglycerides (TG), albumin (ALB), and CK-18 fragments (all P < 0.05). The CK-18 fragment levels showed a significant positive correlation with steatosis severity, ballooning, lobular inflammation, and fibrosis stage (all P < 0.05). Therefore, a new model that combines ALT, platelets, CK-18 fragments, and TG was established by logistic regression among NAFLD patients. The AUROC curve in predicting NASH was 0.920 (95% CI: 0.866 - 0.974, cutoff value = 0.361, sensitivity = 89%, specificity = 86%, positive predictive value = 89%, negative predictive value = 89%). ConclusionThe novel scoring system may be considered as a useful model in predicting the presence of NASH in NAFLD patients.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is a clinicpathological syndrome with a full spectrum that ranges from simple steatosis and nonalcoholic steatohepatitis (NASH) to cirrhosis and hepatocellular carcinoma [1,2]
Compared with the non-NASH group, the levels of body mass index (BMI), waist-on-hip ratio (WHR), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), platelets, uric acid (UA), hs-C-reactive protein (hs-CRP), and TG were significantly higher in the NASH group, whereas ALB was lower (P < 0.05)
Numerous indexes showed no significant differences between the two groups. These indexes include the age of patient, gender, smoking habits, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum bilirubin, white blood cell (WBC), hemoglobin, creatinine, international normalized ratio (INR), Ferritin, fasting glucose (FG), total cholesterol (TC), and the medical history of Diabetes mellitus (DM), hypertension, and dyslipidemia
Summary
Nonalcoholic fatty liver disease (NAFLD) is a clinicpathological syndrome with a full spectrum that ranges from simple steatosis and nonalcoholic steatohepatitis (NASH) to cirrhosis and hepatocellular carcinoma [1,2]. NASH is a more aggressive form of NAFLD, which is characterized by steatosis, hepatocellular injury, lobular inflammation, and the pattern of fibrosis [7,8], and is a potential cause of cirrhosis and end-stage liver disease [9]. The full spectrum of the disease ranges from simple steatosis and nonalcoholic steatohepatitis (NASH) to cirrhosis and hepatocellular carcinoma(HCC). The infiltration of inflammatory cells characterizes NASH This characteristic contributes to the progression of hepatitis, fibrosis, cirrhosis, and HCC. The CK-18 fragment levels showed a significant positive correlation with steatosis severity, ballooning, lobular inflammation, and fibrosis stage (all P < 0.05). Conclusion: The novel scoring system may be considered as a useful model in predicting the presence of NASH in NAFLD patients
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