Predictors of fibrosis in Asian patients with non-alcoholic steatohepatitis.
OBJECTIVE
Non-alcoholic steatohepatitis (NASH) is increasingly recognized as an important cause of chronic liver disease. However, data on Asians with NASH is lacking in the literature. The aim of the present study was to describe the clinical, biochemical and histological characteristics of NASH in Asians and to determine the predictors for septal fibrosis.


METHODS
Sixty consecutive patients aged over 18 years with elevated serum alanine transferase, sonographic evidence of steatosis, and consent for liver biopsy were included. Patients with chronic hepatitis B or C, alcoholic, autoimmune, genetic, or drug-induced liver disease were excluded. Clinical, biochemical and histological variables were tested for association with septal liver fibrosis (F2/3).


RESULTS
Median age of the cohort was 45.5 years (range 21-75 years) and 63% were male. Ninety percent of patients were obese (body mass index [BMI]>or= 25), 70% had hypertriglyceridemia, 68% had hypercholesterolemia, 58% had metabolic syndrome, 53% had hypertension, 47% had diabetes mellitus (DM), and 18% had obstructive sleep apnea. Sixty-eight percent had gamma-glutamyl transferase (GGT) >or= 2 x upper limit of normal (ULN), 55% had alanine aminotransferase (ALT) >or= 2 x ULN, and 23% had aspartate aminotransferase (AST) >or= 2 x ULN. Of the 40 non-diabetic patients undergoing oral glucose tolerance testing, 45% had normal tests, 30% had impaired glucose tolerance, 23% DM, and 2% impaired fasting glucose. Eighteen patients (30%) had septal fibrosis (F2/3), but none had cirrhosis. Necroinflammatory grade >or= 2 (odds ratio [OR] 13), AST >or= 2 x ULN (OR 5.3) and DM (OR 5) were significantly and independently correlated with septal fibrosis.


CONCLUSIONS
Septal fibrosis is common in Asians with NASH. Necroinflammatory grade >or= 2, AST >or= 2 x ULN and DM are independent predictors for septal fibrosis.
Tsang
Steven Woon Choy
SW
Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong, China. tsangwcs@ha.org.hk
Ng
Wing Fung
WF
Wu
Brian Ping Ying
BP
Chow
David Alan
DA
Li
Eric Ting Ho
ET
Wong
Tak Cheung
TC
D000328:Adult; D000368:Aged; D001208:Asia; D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D048909:Diabetes Complications / Q000097:blood / Q000209:etiology* / Q000473:pathology; D005234:Fatty Liver / Q000097:blood / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
D001219:Aspartate Aminotransferases