Clin Mol Hepatol.
2013 Jun;19(2):120-130. 10.3350/cmh.2013.19.2.120.
Noninvasive predictors of nonalcoholic steatohepatitis in Korean patients with histologically proven nonalcoholic fatty liver disease
- Affiliations
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- 1Department of Internal Medicine, Soon Chun Hyang University Hospital Bucheon, Soon Chun Hyang University College of Medicine, Bucheon, Korea.
- 2Department of Pathology, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 3The Catholic University of Korea Liver Research Center & WHO Collaborating Center of Viral Hepatitis, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 4Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. yoonsk@catholic.ac.kr
- 5Department of Internal Medicine, The Catholic University of Korea Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea.
- 6Department of Internal Medicine, The Catholic University of Korea Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 7Department of Internal Medicine, The Catholic University of Korea Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.
- 8Department of Internal Medicine, The Catholic University of Korea St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 9Department of Internal Medicine, The Catholic University of Korea St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
- 10Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea.
- 11Department of Internal Medicine, Soon Chun Hyang University Hospital Seoul, Soon Chun Hyang University College of Medicine, Seoul, Korea.
- 12Department of Pathology, Soon Chun Hyang University Hospital Bucheon, Soon Chun Hyang University College of Medicine, Bucheon, Korea.
- 13Department of Internal Medicine, Chungbuk National University, College of Medicine, Cheongju, Korea.
- KMID: 1776799
- DOI: http://doi.org/10.3350/cmh.2013.19.2.120
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.
MeSH Terms
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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
Biological Markers
Keratin-18
Ferritins
Aspartate Aminotransferases
Alanine Transaminase
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