Modification of a simple clinical scoring system as a diagnostic screening tool for non-alcoholic steatohepatitis in Japanese patients with non-alcoholic fatty liver disease.
OBJECTIVE
We reinvestigated the clinical usefulness of the modified NAFIC scoring system, modified by changing the weightage assigned to the fasting serum insulin level based on the importance of hyperinsulinemia in the pathogenesis of non-alcoholic steatohepatitis (NASH), in Japanese patients with non-alcoholic fatty liver disease (NAFLD) who had undergone liver biopsy.


METHODS
The NAFIC score is conventionally calculated as follows: serum ferritin ≥200 ng/mL (female) or ≥300 ng/mL (male), 1 point; serum fasting insulin ≥10 μU/mL, 1 point; and serum type IV collagen 7 s ≥5.0 ng/mL, 2 points. A total of 147 patients with NAFLD who had undergone liver biopsies were included in the estimation group. To validate the modified scoring system, 355 patients from nine hepatology centers in Japan were also enrolled.


RESULTS
In the estimation group, 74 (50.3%) patients were histologically diagnosed as having NASH, whereas the remaining 73 (49.7%) were diagnosed as not having NASH. As the percentage of NASH patients increased not only among participants with serum insulin levels greater than 10 μU/mL, but also in those with serum levels greater than 15 μU/mL, we advocated use of the modified NAFIC score, as follows: serum fasting insulin 10-15 μU/mL, 1 point and ≥15 μU/mL, 2 points. The modified NAFIC score showed improved sensitivity and negative predictive value for the diagnosis of NASH. This finding was also confirmed in the validation group.


CONCLUSIONS
The modified NAFIC scoring system could be a clinically useful diagnostic screening tool for NASH.
Department of Endocrinology and Metabolism Yokohama City University Yokohama Japan.
Akinobu
A
Nakamura
Division of Gastroenterology Graduate School of Medicine Yokohama City University Yokohama Japan.
Masato
M
Yoneda
Department of Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto Japan.
Yoshio
Y
Sumida
Division of Hepatology Saga Medical School Saga Japan.
Yuichiro
Y
Eguchi
Department of Hepatology Graduate School of Medicine Osaka City University Osaka Japan.
Hideki
H
Fujii
Department of Medicine and Molecular Science Graduate School of Biomedical Sciences Hiroshima University Hiroshima Japan.
Hideyuki
H
Hyogo
Department of Gastroenterology and Hepatology Kochi Medical School Kochi Japan.
Masafumi
M
Ono
Division of Gastroenterology and Hematology/Oncology Department of Medicine Asahikawa Medical College Asahikawa Japan.
Yasuaki
Y
Suzuki
Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan.
Takumi
T
Kawaguchi
School of Biomedical Informatics University of Texas Health Science Center at Houston Houston TX USA.
Noriaki
N
Aoki
Hepatology Center Saiseikai Suita Hospital Suita Japan.
Takeshi
T
Okanoue
Division of Gastroenterology Graduate School of Medicine Yokohama City University Yokohama Japan.
Atsushi
A
Nakajima
Division of Gastroenterology Graduate School of Medicine Yokohama City University Yokohama Japan.
Shin
S
Maeda
Department of Endocrinology and Metabolism Yokohama City University Yokohama Japan.
Yasuo
Y
Terauchi
Insulin; Non‐alcoholic fatty liver disease