title: Predictors of fibrosis in Asian patients with non-alcoholic steatohepatitis.
abstract: 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.
authors.affiliation: Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong, China. tsangwcs@ha.org.hk
authors.forename: Steven Woon Choy
authors.initials: SW
authors.lastname: Tsang
authors.forename: Wing Fung
authors.initials: WF
authors.lastname: Ng
authors.forename: Brian Ping Ying
authors.initials: BP
authors.lastname: Wu
authors.forename: David Alan
authors.initials: DA
authors.lastname: Chow
authors.forename: Eric Ting Ho
authors.initials: ET
authors.lastname: Li
authors.forename: Tak Cheung
authors.initials: TC
authors.lastname: Wong
mesh_terms: 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
chemical_list: D001219:Aspartate Aminotransferases