title: Development and validation of a noninvasive prediction model for nonalcoholic steatohepatitis resolution after lifestyle intervention.
abstract: Liver biopsy is the gold standard method to assess nonalcoholic steatohepatitis (NASH) resolution after therapeutic interventions. We developed and validated a simple and noninvasive scoring system to predict NASH resolution without fibrosis worsening after 1 year of lifestyle intervention. This was a prospective cohort study conducted in 261 patients with histologically proven NASH who were treated with lifestyle changes for 52 weeks and underwent a second liver biopsy to confirm NASH resolution. We divided the data into development (140 subjects) and validation (121 individuals) sets. NASH resolution occurred in 28% (derivation group) and 27% (validation group). At the multivariable analysis, weight loss (odds ratio [OR] = 2.75, 95% confidence interval [CI] 1.65-4.58; P < 0.01), type 2 diabetes (OR = 0.04, 95% CI 0.005-0.49; P = 0.01), normal levels of alanine aminotransferase at the end of intervention (OR = 9.84, 95% CI 2.21-44.1; P < 0.01), age (OR = 0.89, 95% CI 0.83-0.97; P = 0.01), and a nonalcoholic fatty liver activity score ≥5 (OR = 0.08, 95% CI 0.01-0.43; P < 0.01) were independent predictors of NASH resolution. The area under the receiver operating characteristic curve of the selected model was 0.956 and 0.945 in the derivation and validation cohorts, respectively. Using a score threshold of ≤46.15, negative predictive values were 92% in the derivation and validation groups, respectively. By applying a cutoff ≥69.72, positive predictive values were 92% and 89% in the derivation and validation groups, respectively. Using both cutoffs, a liver biopsy would have been avoided in 229 (88%) of 261 patients, with a correct prediction in 209 (91%)
  
  
  
  A noninvasive prediction model including weight loss, type 2 diabetes, alanine aminotransferase normalization, age, and a nonalcoholic fatty liver activity score ≥5 may be useful to identify NASH resolution in patients under lifestyle intervention. (Hepatology 2016;63:1875-1887).
authors: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.|Unit for the Clinical Management of Digestive Diseases, Virgen Macarena-Virgen del Rocio University Hospital, Institute of Biomedicine, Ciberehd, University of Seville, Seville, Spain.
authors: Eduardo
authors: E
authors: Vilar-Gomez
authors: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors: Ali
authors: A
authors: Yasells-Garcia
authors: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors: Yadina
authors: Y
authors: Martinez-Perez
authors: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors: Luis
authors: L
authors: Calzadilla-Bertot
authors: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors: Ana
authors: A
authors: Torres-Gonzalez
authors: Department of Pathology, National Institute of Gastroenterology, Havana, Cuba.
authors: Bienvenido
authors: B
authors: Gra-Oramas
authors: Department of Pathology, National Institute of Gastroenterology, Havana, Cuba.
authors: Licet
authors: L
authors: Gonzalez-Fabian
authors: Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba.
authors: Oscar
authors: O
authors: Villa-Jimenez
authors: Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Scott L
authors: SL
authors: Friedman
authors: Liver Unit, Department of Gastroenterology, Valencia University General Hospital, Valencia, Spain.
authors: Moises
authors: M
authors: Diago
authors: Unit for the Clinical Management of Digestive Diseases, Virgen Macarena-Virgen del Rocio University Hospital, Institute of Biomedicine, Ciberehd, University of Seville, Seville, Spain.
authors: Manuel
authors: M
authors: Romero-Gomez
mesh_terms: D000328:Adult; D005260:Female; D005544:Forecasting; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000628:therapy*