Original Article—Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, Volume 46, Issue 2, pp 257-268

First online:

A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease

  • Yoshio SumidaAffiliated withCenter for Digestive and Liver Diseases, Nara City Hospital Email author 
  • , Masato YonedaAffiliated withDivision of Gastroenterology, Yokohama City University Graduate School of Medicine
  • , Hideyuki HyogoAffiliated withDepartment of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University
  • , Kanji YamaguchiAffiliated withDepartment of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
  • , Masafumi OnoAffiliated withDepartment of Gastroenterology and Hepatology, Kochi Medical School
  • , Hideki FujiiAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
  • , Yuichiro EguchiAffiliated withDepartment of Internal Medicine, Saga Medical School, Saga University
  • , Yasuaki SuzukiAffiliated withDivision of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College
  • , Shunsuke ImaiAffiliated withDepartment of Pathology, Nara City Hospital
    • , Kazuyuki KanemasaAffiliated withCenter for Digestive and Liver Diseases, Nara City Hospital
    • , Koji FujitaAffiliated withDivision of Gastroenterology, Yokohama City University Graduate School of Medicine
    • , Kazuaki ChayamaAffiliated withDepartment of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University
    • , Kohichiroh YasuiAffiliated withDepartment of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
    • , Toshiji SaibaraAffiliated withDepartment of Gastroenterology and Hepatology, Kochi Medical School
    • , Norifumi KawadaAffiliated withDepartment of Hepatology, Graduate School of Medicine, Osaka City University
    • , Kazuma FujimotoAffiliated withDepartment of Internal Medicine, Saga Medical School, Saga University
    • , Yutaka KohgoAffiliated withDivision of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College
    • , Takeshi OkanoueAffiliated withHepatology Center, Saiseikai Suita Hospital
    • , Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

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Abstract

Background

Liver histology is the gold standard for the diagnosis of nonalcoholic steatohepatitis (NASH). Noninvasive, simple, reproducible, and reliable biomarkers are greatly needed to differentiate NASH from nonalcoholic fatty liver disease (NAFLD).

Methods

To construct a scoring system for predicting NASH, 177 Japanese patients with biopsy-proven NAFLD were enrolled. To validate the scoring system, 442 biopsy-proven NAFLD patients from eight hepatology centers in Japan were also enrolled.

Results

In the estimation group, 98 (55%) patients had NASH. Serum ferritin [≥200 ng/ml (female) or ≥300 ng/ml (male)], fasting insulin (≥10 μU/ml), and type IV collagen 7S (≥5.0 ng/ml) were selected as independent variables associated with NASH, by multilogistic regression analysis. These three variables were combined in a weighted sum [serum ferritin ≥200 ng/ml (female) or ≥300 ng/ml (male) = 1 point, fasting insulin ≥10 μU/ml = 1 point, and type IV collagen 7S ≥5.0 ng/ml = 2 points] to form an easily calculated composite score for predicting NASH, called the NAFIC score. The area under the receiver operating characteristic (AUROC) curve for predicting NASH was 0.851 in the estimation group and 0.782 in the validation group. The NAFIC AUROC was the greatest among several previously established scoring systems for detecting NASH, but also for predicting severe fibrosis.

Conclusions

NAFIC score can predict NASH in Japanese NAFLD patients with sufficient accuracy and simplicity to be considered for clinical use.

Keywords

Iron overload Hepatic fibrosis Nonalcoholic steatohepatitis