title: Cytokeratin 18, alanine aminotransferase, platelets and triglycerides predict the presence of nonalcoholic steatohepatitis.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is one of the critical public health problems in China. The full spectrum of the disease ranges from simple steatosis and nonalcoholic steatohepatitis (NASH) to cirrhosis and hepatocellular carcinoma(HCC). The infiltration of inflammatory cells characterizes NASH. This characteristic contributes to the progression of hepatitis, fibrosis, cirrhosis, and HCC. Therefore, distinguishing NASH from NAFLD is crucial.
  
  
  OBJECTIVE
  Ninety-five patients with NAFLD, 44 with NASH, and 51 with non-NASH were included in the study to develop a new scoring system for differentiating NASH from NAFLD. Data on clinical and biological characteristics, as well as blood information, were obtained. Cytokeratin-18 (CK-18) fragments levels were measured using an enzyme-linked immunosorbant assay.
  
  
  RESULTS
  Several indexes show significant differences between the two groups, which include body mass index (BMI), waist-on-hip ratio (WHR), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), platelets, uric acid (UA), hs-C-reactive protein (hs-CRP), triglycerides (TG), albumin (ALB), and CK-18 fragments (all P < 0.05). The CK-18 fragment levels showed a significant positive correlation with steatosis severity, ballooning, lobular inflammation, and fibrosis stage (all P < 0.05). Therefore, a new model that combines ALT, platelets, CK-18 fragments, and TG was established by logistic regression among NAFLD patients. The AUROC curve in predicting NASH was 0.920 (95% CI: 0.866 - 0.974, cutoff value = 0.361, sensitivity = 89%, specificity = 86%, positive predictive value = 89%, negative predictive value = 89%).
  
  
  CONCLUSIONS
  The novel scoring system may be considered as a useful model in predicting the presence of NASH in NAFLD patients.
authors: Department of Infectious Diseases, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors: Wei
authors: W
authors: Cao
authors: Caiyan
authors: C
authors: Zhao
authors: Chuan
authors: C
authors: Shen
authors: Yadong
authors: Y
authors: Wang
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001792:Blood Platelets / Q000378:metabolism*; D005234:Fatty Liver / Q000097:blood* / Q000201:enzymology* / Q000473:pathology; D005260:Female; D006801:Humans; D053538:Keratin-18 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D011379:Prognosis; D012372:ROC Curve; D014280:Triglycerides / Q000097:blood*
chemical_list: D053538:Keratin-18; D014280:Triglycerides; D000410:Alanine Transaminase