Discrimination of Nonalcoholic Steatohepatitis Using Transient Elastography in Patients with Nonalcoholic Fatty Liver Disease.
OBJECTIVE
The accuracy of noninvasive markers to discriminate nonalcoholic steatohepatitis (NASH) is unsatisfactory. We investigated whether transient elastography (TE) could discriminate patients with NASH from those with nonalcoholic fatty liver disease (NAFLD).


METHODS
The patients suspected of NAFLD who underwent liver biopsy and concomitant TE were recruited from five tertiary centers between November 2011 and December 2013.


RESULTS
The study population (n = 183) exhibited a mean age of 40.6 years and male predominance (n = 111, 60.7%). Of the study participants, 89 (48.6%) had non-NASH and 94 (51.4%) had NASH. The controlled attenuation parameter (CAP) and liver stiffness (LS) were significantly correlated with the degrees of steatosis (r = 0.656, P<0.001) and fibrosis (r = 0.714, P<0.001), respectively. The optimal cut-off values for steatosis were 247 dB/m for S1, 280 dB/m for S2, and 300 dB/m for S3. Based on the independent predictors derived from multivariate analysis [P = 0.044, odds ratio (OR) 4.133, 95% confidence interval (CI) 1.037-16.470 for CAP>250 dB/m; P = 0.013, OR 3.399, 95% CI 1.295-8.291 for LS>7.0 kPa; and P<0.001, OR 7.557, 95% CI 2.997-19.059 for Alanine aminotransferase>60 IU/L], we developed a novel CLA model for discriminating patients with NASH. The CLA model showed good discriminatory capability, with an area under the receiver operating characteristic curve (AUROC) of 0.812 (95% CI 0.724-0.880). To assess discriminatory power, the AUROCs, as determined by the bootstrap method, remained largely unchanged between iterations, with an average value of 0.833 (95% CI 0.740-0.893).


CONCLUSIONS
This novel TE-based CLA model showed acceptable accuracy in discriminating NASH from simple steatosis. However, further studies are required for external validation.
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Hye Won
HW
Lee
Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Seoul, Korea.
Soo Young
SY
Park
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Seung Up
SU
Kim
Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea.
Jae Young
JY
Jang
Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Bundang, Korea.
Hana
H
Park
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Ja Kyung
JK
Kim
National Health Insurance Cooperation, Ilsan Hospital, Ilsan, Korea.
Chun Kyon
CK
Lee
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Young Eun
YE
Chon
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Kwang-Hyub
KH
Han
D000328:Adult; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005234:Fatty Liver / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging*; D016017:Odds Ratio; D011237:Predictive Value of Tests