title: Noninvasive predictors of nonalcoholic steatohepatitis in Korean patients with histologically proven nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  The aims of this study were (1) to identify the useful clinical parameters of noninvasive approach for distinguishing nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver disease (NAFLD), and (2) to determine whether the levels of the identified parameters are correlated with the severity of liver injury in patients with NASH.
  
  
  METHODS
  One hundred and eight consecutive patients with biopsy-proven NAFLD (age, 39.8±13.5 years, mean±SD; males, 67.6%) were prospectively enrolled from 10 participating centers across Korea.
  
  
  RESULTS
  According to the original criteria for NAFLD subtypes, 67 patients (62.0%) had NASH (defined as steatosis with hepatocellular ballooning and/or Mallory-Denk bodies or fibrosis ≥2). Among those with NAFLD subtype 3 or 4, none had an NAFLD histologic activity score (NAS) below 3 points, 40.3% had a score of 3 or 4 points, and 59.7% had a score >4 points. Fragmented cytokeratin-18 (CK-18) levels were positively correlated with NAS (r=0.401), as well as NAS components such as lobular inflammation (r=0.387) and ballooning (r=0.231). Fragmented CK-18 was also correlated with aspartate aminotransferase (r=0.609), alanine aminotransferase (r=0.588), serum ferritin (r=0.432), and the fibrosis stage (r=0.314). A fragmented CK-18 cutoff level of 235.5 U/L yielded sensitivity, specificity, and positive and negative predictive values of 69.0%, 64.9%, 75.5% (95% CI 62.4-85.1), and 57.1% (95% CI 42.2-70.9), respectively, for the diagnosis of NASH.
  
  
  CONCLUSIONS
  Serum fragmented CK-18 levels can be used to distinguish between NASH and NAFL. Further evaluation is required to determine whether the combined measurement of serum CK-18 and ferritin levels improves the diagnostic performance of this distinction.
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University Hospital Bucheon, Soon Chun Hyang University College of Medicine, Bucheon, Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jung
authors.forename: Wonhee
authors.initials: W
authors.lastname: Hur
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Myeong Jun
authors.initials: MJ
authors.lastname: Song
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Jo
authors.forename: Chang Don
authors.initials: CD
authors.lastname: Lee
authors.forename: Young Sok
authors.initials: YS
authors.lastname: Lee
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Choi
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Yang
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Sang Gyune
authors.initials: SG
authors.lastname: Kim
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Jung
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Kim
authors.forename: Hee Bok
authors.initials: HB
authors.lastname: Chae
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D044466:Asian People; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005234:Fatty Liver / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005293:Ferritins / Q000097:blood; D005355:Fibrosis / Q000150:complications; D006801:Humans; D053538:Keratin-18 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011237:Predictive Value of Tests; D011446:Prospective Studies; D056910:Republic of Korea; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D053538:Keratin-18; D005293:Ferritins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Cytokeratin-18; Ferritin; Nonalcoholic fatty liver disease