title: Noninvasive scoring systems in patients with nonalcoholic fatty liver disease with normal alanine aminotransferase levels.
abstract: BACKGROUND
  The severity of liver fibrosis must be estimated to determine the prognosis, for surveillance, and for optimal treatment of nonalcoholic fatty liver disease (NAFLD). However, the severity of hepatic fibrosis tends to be underestimated in patients with normal ALT.
  
  
  METHODS
  We investigated histological data and scoring systems (FIB-4 index, NAFLD fibrosis score, BARD score, and AST/ALT ratio) of 1,102 liver-biopsy-confirmed NAFLD patients.
  
  
  RESULTS
  A total of 235 NAFLD patients with normal ALT were estimated to exist. The ratio of advanced fibrosis (stage 3-4) was seen in 16.1 % of subjects with normal ALT. Scoring systems, especially the FIB-4 index and NAFLD fibrosis score, were clinically very useful (AUROC >0.8), even in patients with normal ALT. Furthermore, with resetting of the cutoff values, the FIB-4 index (>1.659) and NAFLD fibrosis score (>0.735) were found to have a higher sensitivity and higher specificity for the prediction of advanced fibrosis, and all of these scoring systems (FIB-4 index, NAFLD fibrosis score, BARD score, and AST/ALT ratio) had higher negative predictive values (>90.3 %). By using the resetting cutoff value, liver biopsy could have been avoided in 60.4 % (FIB-4), 66.4 % (NAFLD fibrosis score), 51.9 % (BARD score), and 62.1 % (AST/ALT ratio).
  
  
  CONCLUSIONS
  We reset the cutoff values of numerous non-invasive scoring systems to improve their clinical usefulness in the prediction of liver fibrosis in NAFLD patients with normal ALT, and these non-invasive scoring systems with the reset cutoff values could be of substantial benefit to reduce the number of liver biopsies performed.
authors.affiliation: Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Kento
authors.initials: K
authors.lastname: Imajo
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sumida
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hyogo
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ono
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Takumi
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Aoki
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kanemasa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kohgo
authors.forename: Toshiji
authors.initials: T
authors.lastname: Saibara
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Itoh
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Keizo
authors.initials: K
authors.lastname: Anzai
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000886:Anthropometry / Q000379:methods; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004796:Clinical Enzyme Tests; D024141:Collagen Type IV / Q000097:blood; D005188:False Negative Reactions; D005234:Fatty Liver / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D024141:Collagen Type IV; D000410:Alanine Transaminase