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KMID : 1103920130190020120
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Korean Journal of Hepatology
2013 Volume.19 No. 2 p.120 ~ p.130
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Noninvasive predictors of nonalcoholic steatohepatitis in Korean patients with histologically proven nonalcoholic fatty liver disease
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Kim Young-Seok
Jung Eun-Sun
Hur Won-Hee
Bae Si-Hyun
Choi Jong-Young
Song Myeong-Jun
Kim Chang-Wook
Jo Se-Hyun
Lee Chang-Don
Lee Young-Sok
Choi Sang-Wook
Yang Jin-Mo
Jang Jeong-Won
Kim Sang-Gyune
Jung Seung-Won
Kim Hee-Kyung
Chae Hee-Bok
Yoon Seung-Kew
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Abstract
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Background/Aims: The aims of this study were (1) to identify the useful clinical parameters of noninvasive approach for distinguishing nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver disease (NAFLD), and (2) to determine whether the levels of the identified parameters are correlated with the severity of liver injury in patients with NASH.
Methods: One hundred and eight consecutive patients with biopsy-proven NAFLD (age, 39.8±13.5 years, mean±SD; males, 67.6%) were prospectively enrolled from 10 participating centers across Korea.
Results: According to the original criteria for NAFLD subtypes, 67 patients (62.0%) had NASH (defined as steatosis with hepatocellular ballooning and/or Mallory-Denk bodies or fibrosis ≥2). Among those with NAFLD subtype 3 or 4, none had an NAFLD histologic activity score (NAS) below 3 points, 40.3% had a score of 3 or 4 points, and 59.7% had a score >4 points. Fragmented cytokeratin-18 (CK-18) levels were positively correlated with NAS (r=0.401), as well as NAS hecomponents such as lobular inflammation (r=0.387) and ballooning (r=0.231). Fragmented CK-18 was also correlated with aspartate aminotransferase (r=0.609), alanine aminotransferase (r=0.588), serum ferritin (r=0.432), and the fibrosis stage (r=0.314). A fragmented CK-18 cutoff level of 235.5 U/L yielded sensitivity, specificity, and positive and negative predictive values of 69.0%, 64.9%, 75.5% (95% CI 62.4?85.1), and 57.1% (95% CI 42.2?70.9), respectively, for the diagnosis of NASH.
Conclusions: Serum fragmented CK-18 levels can be used to distinguish between NASH and NAFL. Further evaluation is required to determine whether the combined measurement of serum CK-18 and ferritin levels improves the diagnostic performance of this distinction.
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KEYWORD
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Nonalcoholic fatty liver disease, Cytokeratin-18, Ferritin
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