A diagnostic model to differentiate simple steatosis from nonalcoholic steatohepatitis based on the likelihood ratio form of Bayes theorem.
OBJECTIVE
To evaluate the performance of a diagnostic model based on a composite index using clinical and laboratory data, including cardiovascular biomarkers, to help practitioners to differentiate patients with simple steatosis from those with nonalcoholic steatohepatitis (NASH).


METHODS
101 patients with biopsy proven features of nonalcoholic fatty liver disease were included. We investigated the usefulness of 9 biomarkers in predicting the histological disease severity, including routine biochemical tests, C-reactive protein, soluble intercellular adhesion molecule-1 (sICAM-1) and anthropometric evaluation. Receiver operating characteristic (ROC) curves and likelihood ratios (LRs) were used to evaluate the fit of each test. A composite index was calculated as the product of each individual test LR.


RESULTS
In a model patient who has all positive tests, the post-test probability for NASH would be 99.5%.


CONCLUSIONS
The capacity of each individual biomarker to independently predict the disease outcome was lower than a composite index constructed after multiplying the LR for each individual test combined into a "multimarker" score.
Sookoian
Silvia
S
Department of Molecular Genetics and Biology of Complex Diseases, Laboratory of Clinical and Molecular Hepatology, Institute of Medical Research, University of Buenos Aires-CONICET, Ciudad Autónoma de Buenos Aires, Argentina. ssookoian@lanari.fmed.uba.ar
Castaño
Gustavo
G
Burgueño
Adriana Laura
AL
Gianotti
Tomas Fernández
TF
Rosselli
María Soledad
MS
Pirola
Carlos Jose
CJ
D001499:Bayes Theorem; D002097:C-Reactive Protein / Q000378:metabolism; D005234:Fatty Liver / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D008107:Liver Diseases / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein