Distinguishing an alcohol basis from a nonalcoholic basis for the clinical and histologic spectrum of steatohepatitic liver disease is difficult.
The diagnosis is made difficult because of unreliability of alcohol consumption history.
Unfortunately, various biomarkers have had limited utility in distinguishing alcoholic liver disease from nonalcoholic fatty liver disease.
Dr Winston Dunn and colleagues from England created and validated a model to diagnose alcoholic liver disease in patients with steatohepatitis.
The team performed a cross-sectional cohort study at the Mayo Clinic, Minnesota, to create a model using multivariable logistic regression analysis.
This model was validated in 3 independent data sets comprising patients of varying severity of steatohepatitis spanning over 10 years.
|Body mass index helps distinguish alcoholic from nonalcoholic fatty liver disease|
The team identified mean corpuscular volume, and aspartate aminotransferase/alanine aminotransfersase ratio as important distinguishing variables.
Body mass index, and gender were also variables that separated patients with alcoholic liver disease from nonalcoholic fatty liver disease.
The team used these variables were generate the alcoholic liver disease/nonalcoholic fatty liver disease index.
A disease index greater than zero incrementally favoring alcoholic liver disease.
Inversely, the researchers noted that a disease index of less than zero incrementally favored a diagnosis of nonalcoholic fatty liver disease.
The team observed that the index performance characteristics were better than several biomarkers used to differentiate alcoholic from nonalcoholic fatty liver.
The biomarkers included histopathologic marker protein tyrosine phosphatase 1b, and aspartate aminotransferase/alanine aminotransfersase ratio.
The researchers also compared the model to the biomarkers γ-glutamyl transferase, and carbohydrate-deficient transferrin.
Dr Dunn's team concludes, “The alcoholic liver disease/nonalcoholic fatty liver disease index is derived from easily available objective variables.”
“It accurately differentiates alcoholic liver disease from nonalcoholic fatty liver disease in hospitalized, ambulatory, and pretransplantation patients”
“The index compares favorably with other traditional and proposed biomarkers.”