Useful parameters for distinguishing nonalcoholic steatohepatitis with mild steatosis from cryptogenic chronic hepatitis in the Japanese population.
OBJECTIVE
As detecting mild steatosis is difficult by abdominal ultrasonography (US), nonalcoholic steatohepatitis (NASH) with mild steatosis may sometimes be confused with cryptogenic chronic hepatitis. We aimed to test this possibility and to isolate factors that may indicate NASH.


METHODS
First, 53 Japanese patients diagnosed as having cryptogenic chronic hepatitis by laboratory examination and US were enrolled. These patients were histologically divided into NASH and non-NASH groups, and their clinical features were compared. Second, the diagnostic accuracy of predictors of NASH was examined prospectively.


RESULTS
Fifteen patients (28%) were histologically diagnosed as having NASH with mild steatosis. Multivariable analysis revealed that body mass index (BMI) and serum ferritin level were independent predictors of NASH. The best cutoff values to detect NASH were assessed by using receiver-operating characteristic curves: BMI>25.2 kg/m(2) and serum ferritin level >142 ng/ml. When both markers were concomitantly negative, the negative predictive value to detect NASH was 100%.


CONCLUSIONS
In cases of mild steatosis, US is not a perfect tool for the accurate diagnosis of NASH. BMI and serum ferritin level are useful discriminators of NASH from cryptogenic chronic hepatitis, and might be helpful markers for diagnosing NASH more accurately in Japanese patients.
Tanaka
Naoki
N
Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan. naopi@hsp.md.shinshu-u.ac.jp
Tanaka
Eiji
E
Sheena
Yo
Y
Komatsu
Michiharu
M
Okiyama
Wataru
W
Misawa
Noriko
N
Muto
Hidetomo
H
Umemura
Takeji
T
Ichijo
Tetsuya
T
Matsumoto
Akihiro
A
Yoshizawa
Kaname
K
Horiuchi
Akira
A
Kiyosawa
Kendo
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D002648:Child; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006521:Hepatitis, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012189:Retrospective Studies; D014463:Ultrasonography