A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients.
BACKGROUND
Non-invasive approaches are useful to differentiate simple steatosis from non-alcoholic steatohepatitis (NASH) in obese and morbidly obese patients.


OBJECTIVE
To develop a new scoring system to diagnose definitive NASH.


METHODS
Preoperative clinical and biological data including serum caspase 3-generated cytokeratin-18 fragments (CK18) and surgical liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group (n = 310) and validation group (n = 154). Definitive NASH was defined according to Kleiner's classification with a Non-alcoholic fatty liver disease Activity Score (NAS) ≥5.


RESULTS
Alanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome were independent predictors for discriminating patients with NAS ≥5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS ≥5. Whereas serum CK18 fragment alone had an area under the receiver operating characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training group and the validation group, respectively.


CONCLUSIONS
A simple and non-invasive composite model (the Nice Model) including metabolic syndrome, ALT and CK18 fragments is able to predict accurately a non-alcoholic fatty liver disease activity score ≥5 in morbidly obese subjects.
Institut National de la Santé et de la Recherche Médicale, Nice, France. anty.r@chu-nice.fr
R
R
Anty
A
A
Iannelli
S
S
Patouraux
S
S
Bonnafous
V J
VJ
Lavallard
M
M
Senni-Buratti
I Ben
IB
Amor
A
A
Staccini-Myx
M-C
MC
Saint-Paul
F
F
Berthier
P-M
PM
Huet
Y
Y
Le Marchand-Brustel
J
J
Gugenheim
P
P
Gual
A
A
Tran
D000328:Adult; D000410:Alanine Transaminase; D015992:Body Mass Index; D016022:Case-Control Studies; D005234:Fatty Liver / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D053538:Keratin-18; D008111:Liver Function Tests; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D008954:Models, Biological; D009767:Obesity, Morbid / Q000150:complications*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013223:Statistics as Topic
D053538:Keratin-18; D000410:Alanine Transaminase