title: A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease.
abstract: 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.
authors.affiliation: Center for Digestive and Liver Diseases, Nara City Hospital, Higashi Kidera-cho 1-50-1, Nara 630-8305, Japan. sumida@nara-jadecom.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sumida
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hyogo
authors.forename: Kanji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ono
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Imai
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kanemasa
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.forename: Kohichiroh
authors.initials: K
authors.lastname: Yasui
authors.forename: Toshiji
authors.initials: T
authors.lastname: Saibara
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kawada
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kohgo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue
mesh_terms: 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
chemical_list: D015415:Biomarkers; D024141:Collagen Type IV; D007328:Insulin; D005293:Ferritins