Noninvasive predictors of nonalcoholic steatohepatitis in Korean patients with histologically proven nonalcoholic fatty liver disease.
10.3350/cmh.2013.19.2.120
- Author:
Young Seok KIM
1
;
Eun Sun JUNG
;
Wonhee HUR
;
Si Hyun BAE
;
Jong Young CHOI
;
Myeong Jun SONG
;
Chang Wook KIM
;
Se Hyun JO
;
Chang Don LEE
;
Young Sok LEE
;
Sang Wook CHOI
;
Jin Mo YANG
;
Jeong Won JANG
;
Sang Gyune KIM
;
Seung Won JUNG
;
Hee Kyung KIM
;
Hee Bok CHAE
;
Seung Kew YOON
Author Information
1. Department of Internal Medicine, Soon Chun Hyang University Hospital Bucheon, Soon Chun Hyang University College of Medicine, Bucheon, Korea.
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Nonalcoholic fatty liver disease;
Cytokeratin-18;
Ferritin
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Alanine Transaminase/blood;
Asian Continental Ancestry Group;
Aspartate Aminotransferases/blood;
Biological Markers/blood;
Fatty Liver/classification/metabolism/*pathology;
Female;
Ferritins/blood;
Fibrosis/complications;
Humans;
Keratin-18/analysis;
Male;
Middle Aged;
Predictive Value of Tests;
Prospective Studies;
Republic of Korea;
Severity of Illness Index;
Young Adult
- From:Clinical and Molecular Hepatology
2013;19(2):120-130
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: The aims of this study were (1) to identify the useful clinical parameters of noninvasive approach for distinguishing nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver disease (NAFLD), and (2) to determine whether the levels of the identified parameters are correlated with the severity of liver injury in patients with NASH. METHODS: One hundred and eight consecutive patients with biopsy-proven NAFLD (age, 39.8+/-13.5 years, mean+/-SD; males, 67.6%) were prospectively enrolled from 10 participating centers across Korea. RESULTS: According to the original criteria for NAFLD subtypes, 67 patients (62.0%) had NASH (defined as steatosis with hepatocellular ballooning and/or Mallory-Denk bodies or fibrosis > or =2). Among those with NAFLD subtype 3 or 4, none had an NAFLD histologic activity score (NAS) below 3 points, 40.3% had a score of 3 or 4 points, and 59.7% had a score >4 points. Fragmented cytokeratin-18 (CK-18) levels were positively correlated with NAS (r=0.401), as well as NAS components such as lobular inflammation (r=0.387) and ballooning (r=0.231). Fragmented CK-18 was also correlated with aspartate aminotransferase (r=0.609), alanine aminotransferase (r=0.588), serum ferritin (r=0.432), and the fibrosis stage (r=0.314). A fragmented CK-18 cutoff level of 235.5 U/L yielded sensitivity, specificity, and positive and negative predictive values of 69.0%, 64.9%, 75.5% (95% CI 62.4-85.1), and 57.1% (95% CI 42.2-70.9), respectively, for the diagnosis of NASH. CONCLUSIONS: Serum fragmented CK-18 levels can be used to distinguish between NASH and NAFL. Further evaluation is required to determine whether the combined measurement of serum CK-18 and ferritin levels improves the diagnostic performance of this distinction.
