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Distinguishing nonalcoholic steatohepatitis from simple fatty liver

The latest issue of Liver International proposes a noninvasive screening model for distinguishing simple steatosis from nonalcoholic steatohepatitis, to help identify those who may benefit from liver biopsy.

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Nonalcoholic fatty liver disease encompasses both simple steatosis and nonalcoholic steatohepatitis.

Differentiation of these two entities requires histopathologic evaluation.

Dr Nicole Palekar established a reliable diagnostic model for differentiating steatosis from steatohepatitis.

The research team utilized both clinical characteristics and a panel of biochemical markers of lipid peroxidation and fibrosis.

The team enrolled 80 subjects with biopsy proven nonalcoholic fatty liver disease.

Of these, 39 had simple steatosis and 41 subjects had histopathologic evidence of nonalcoholic steatohepatitis.

Data included serologic testing for 8-epiprostaglandin F, transforming growth factor-β, adiponectin, and hyaluronic acid.

The team compared the results between the 2 groups.

There were significant differences between the 2 groups with respect to age, female gender, aspartate aminotransferase.

The presence of 3 or more risk factors had a sensitivity of 74%
Liver International

Body mass index, fasting insulin, and aspartate aminotransferase or alanine aminotransferase ratio also differed.

The team found that quantitative insulin sensitivity check index, and hyaluronic acid differed between the 2 groups.

Hyaluronic acid composite index for distinguishing steatosis from nonalcoholic steatohepatitis was calculated.

The team calculated this index by summing up risk factors that included age 50 years or more, and female gender.

Other risk factors assessed were aspartate aminotransferase 45 IU/l or more, and body mass index 30 mg/kg2 or more.

The index was also calculated by an aspartate aminotransferase/alanine aminotransferase ratio of 0.8 or more, and hyaluronic acid of 55 mcg/l or more.

The team determined the accuracy of the index by receiver operating characteristic analysis, and found this to be 0.76.

The presence of 3 or more risk factors had a sensitivity of 74% and a specificity of 66%.

In addition, the researchers noted that a hyaluronic acid cutoff of 45 mcg/l was a good predictor of advanced fibrosis.

Dr Palekar's team concludes, “We propose a noninvasive screening model for distinguishing simple steatosis from nonalcoholic steatohepatitis.”

“Identifying patients at risk for nonalcoholic steatohepatitis will allow clinicians to more accurately determine who may benefit from liver biopsy.”

Liv Int 2006: 26(2): 151
27 February 2006

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