The diagnostic value of biomarkers (AshTest) for the prediction of alcoholic steato-hepatitis in patients with chronic alcoholic liver disease.
OBJECTIVE
The aim was to identify a panel of biomarkers (AshTest) for the diagnosis of alcoholic steato-hepatitis (ASH), in patients with chronic alcoholic liver disease.


METHODS
Biomarkers were assessed in patients with an alcohol intake>50 g/d, in a training group, and in two validation groups. Diagnosis of ASH (polymorphonuclear infiltrate and hepatocellular necrosis) and its histological severity (four classes: none, mild, moderate and severe) were assessed blindly.


RESULTS
Two hundred and twenty-five patients were included, 70 in the training group, 155 in the validation groups, and 299 controls. AshTest was constructed using a combination of the six components of FibroTest-ActiTest plus aspartate aminotransferase. The AshTest area under the ROC curves for moderate-severe ASH was 0.90 in the training group, 0.88 and 0.89 in the validation groups. The median AshTest value was 0.005 in controls, 0.05 in patients without or with mild ASH, 0.64 in moderate, and 0.84 in severe ASH grade 3, (P<0.05 between all groups). At a 0.50 cut-off, the sensitivity of AshTest was 0.80 and the specificity was 0.84.


CONCLUSIONS
In heavy drinkers, AshTest is a simple and non-invasive quantitative estimate of alcoholic hepatitis. The use of AshTest may reduce the need for liver biopsy, and therefore allow an earlier treatment of alcoholic hepatitis.
Department of Hepato-Gastroenterology, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 CNRS UMR 8149, Paris Cedex 13, France.
Dominique
D
Thabut
Sylvie
S
Naveau
Frederic
F
Charlotte
Julien
J
Massard
Vlad
V
Ratziu
Françoise
F
Imbert-Bismut
Dominique
D
Cazals-Hatem
Annie
A
Abella
Djamila
D
Messous
Fabienne
F
Beuzen
Mona
M
Munteanu
Julien
J
Taieb
Richard
R
Moreau
Didier
D
Lebrec
Thierry
T
Poynard
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease; D005235:Fatty Liver, Alcoholic / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006519:Hepatitis, Alcoholic / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results
D015415:Biomarkers