A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease.
BACKGROUND
Liver histology is the gold standard for the diagnosis of nonalcoholic steatohepatitis (NASH). Noninvasive, simple, reproducible, and reliable biomarkers are greatly needed to differentiate NASH from nonalcoholic fatty liver disease (NAFLD).


METHODS
To construct a scoring system for predicting NASH, 177 Japanese patients with biopsy-proven NAFLD were enrolled. To validate the scoring system, 442 biopsy-proven NAFLD patients from eight hepatology centers in Japan were also enrolled.


RESULTS
In the estimation group, 98 (55%) patients had NASH. Serum ferritin [≥200 ng/ml (female) or ≥300 ng/ml (male)], fasting insulin (≥10 μU/ml), and type IV collagen 7S (≥5.0 ng/ml) were selected as independent variables associated with NASH, by multilogistic regression analysis. These three variables were combined in a weighted sum [serum ferritin ≥200 ng/ml (female) or ≥300 ng/ml (male) = 1 point, fasting insulin ≥10 μU/ml = 1 point, and type IV collagen 7S ≥5.0 ng/ml = 2 points] to form an easily calculated composite score for predicting NASH, called the NAFIC score. The area under the receiver operating characteristic (AUROC) curve for predicting NASH was 0.851 in the estimation group and 0.782 in the validation group. The NAFIC AUROC was the greatest among several previously established scoring systems for detecting NASH, but also for predicting severe fibrosis.


CONCLUSIONS
NAFIC score can predict NASH in Japanese NAFLD patients with sufficient accuracy and simplicity to be considered for clinical use.
Sumida
Yoshio
Y
Center for Digestive and Liver Diseases, Nara City Hospital, Higashi Kidera-cho 1-50-1, Nara 630-8305, Japan. sumida@nara-jadecom.jp
Yoneda
Masato
M
Hyogo
Hideyuki
H
Yamaguchi
Kanji
K
Ono
Masafumi
M
Fujii
Hideki
H
Eguchi
Yuichiro
Y
Suzuki
Yasuaki
Y
Imai
Shunsuke
S
Kanemasa
Kazuyuki
K
Fujita
Koji
K
Chayama
Kazuaki
K
Yasui
Kohichiroh
K
Saibara
Toshiji
T
Kawada
Norifumi
N
Fujimoto
Kazuma
K
Kohgo
Yutaka
Y
Okanoue
Takeshi
T
D015415:Biomarkers / Q000097:blood; D024141:Collagen Type IV / Q000097:blood*; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005293:Ferritins / Q000097:blood*; D005355:Fibrosis; D006801:Humans; D007328:Insulin / Q000097:blood*; D007564:Japan; D008099:Liver / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D011237:Predictive Value of Tests; D012372:ROC Curve
D015415:Biomarkers; D024141:Collagen Type IV; D007328:Insulin; D005293:Ferritins