title: Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease.
abstract: The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) was formed to conduct multicenter studies on the etiology, contributing factors, natural history, and treatment of nonalcoholic steatohepatitis (NASH). The aim of this study was to determine the associations of readily available demographic, clinical, and laboratory variables with the diagnosis of NASH and its key histological features, and determine the ability of these variables to predict the severity of nonalcoholic fatty liver disease (NAFLD). A total of 1266 adults were enrolled in NASH CRN studies between October 2004 and February 2008, of whom 1101 had available liver histology. The median age was 50 years; 82% were white and 12% Hispanic. The median body mass index was 33 kg/m(2); 49% had hypertension and 31% had type 2 diabetes. On liver biopsy, 57% were judged to have definite NASH and 31% bridging fibrosis or cirrhosis. Using data from the 698 patients with liver biopsies within 6 months of clinical data, patients with definite NASH were more likely to be female and have diabetes, higher levels of aspartate and alanine aminotransferases, alkaline phosphatase, gamma glutamyl transpeptidase, and homeostasis model assessment of insulin resistance (HOMA-IR). Progressive models for predicting histological diagnoses performed modestly for predicting steatohepatitis or ballooning (area under receiver operating characteristic curves [AUROC] ranged from 0.70-0.79), and better for advanced fibrosis (AUROC 0.73-0.85).
  
  
  CONCLUSIONS
  Readily available clinical and laboratory variables can predict advanced fibrosis in adults with NAFLD, but additional information is needed to reliably predict the presence and severity of NASH. Prospective studies of this well-characterized population and associated tissue bank samples offer a unique opportunity to better understand the cause and natural history of NAFLD and develop more precise means for noninvasive diagnosis.
authors.affiliation: Saint Louis University School of Medicine, St. Louis, MO, USA. tetriba@slu.edu
authors.forename: Brent A
authors.initials: BA
authors.lastname: Neuschwander-Tetri
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Bass
authors.forename: Mark L
authors.initials: ML
authors.lastname: Van Natta
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.forename: James
authors.initials: J
authors.lastname: Tonascia
authors.forename: Claudia O
authors.initials: CO
authors.lastname: Zein
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Brunt
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: McCullough
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Anna Mae
authors.initials: AM
authors.lastname: Diehl
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.forename: Naga
authors.initials: N
authors.lastname: Chalasani
authors.forename: Kris V
authors.initials: KV
authors.lastname: Kowdley
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001706:Biopsy; D015992:Body Mass Index; D005234:Fatty Liver / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology*; D008103:Liver Cirrhosis / Q000201:enzymology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase