title: Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD.
abstract: OBJECTIVE
  This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China.
  
  
  METHODS
  A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods.
  
  
  RESULTS
  ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. -3.09 ± 3.89, p < 0.001). With a cut-off value of -0.22, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of diagnosed ALD cases was 87.1%, 92.5%, and 0.934 (95% confidence interval [CI], 0.879 to 0.969), respectively. The corresponding values for aspartate aminotransferase (AST)/alanine transaminase (ALT), mean corpuscular volume (MCV), and GGT were 75.29%, 72.94%, and 0.826 (95% CI, 0.752 to 0.885); 94.34%, 83.02%, and 0.814 (95% CI, 0.739 to 0.875) and 80.23%, 79.25%, and 0.815 (95% CI, 0.740 to 0.876), respectively. ANI AUROC was significantly higher than the AST/ALT, MCV, or GGT AUROCs (all p < 0.001), moreover, ANI showed better diagnostic performance. The combination of ANI and GGT showed a better AUROC than ANI alone (0.976 vs. 0.934, p = 0.016). The difference in AUROCs between AST/ALT, MCV, and GGT was not statistically significant (all p > 0.05).
  
  
  CONCLUSIONS
  ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.
authors.affiliation: Graduate School of Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Junling
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department II of Chinese Integrative Medicine, Tianjin Second People's Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Tianjin University of Traditional Chinese Medicine, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Zhilong
authors.initials: Z
authors.lastname: Jiang
authors.affiliation: Graduate School of Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Qiuhui
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department II of Chinese Integrative Medicine, Tianjin Second People's Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Yuqiang
authors.initials: Y
authors.lastname: Mi
authors.affiliation: Department of Pathology, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Yonggang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Pathology, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Ruifang
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Radiology, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Yonghe
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Radiology, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department II of Chinese Integrative Medicine, Tianjin Second People's Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.affiliation: Tianjin University of Traditional Chinese Medicine, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Si
authors.initials: S
authors.lastname: Li
authors.affiliation: Tianjin University of Traditional Chinese Medicine, Tianjin Second People's Hospital, Tianjin, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002681:China; D004796:Clinical Enzyme Tests; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human
keywords: ALD/NAFLD index; Diagnosis, differential; Gamma-glutamyltransferase; Liver diseases, alcoholic; Non-alcoholic fatty liver disease