A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease
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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).
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.
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.
NAFIC score can predict NASH in Japanese NAFLD patients with sufficient accuracy and simplicity to be considered for clinical use.
KeywordsIron overload Hepatic fibrosis Nonalcoholic steatohepatitis
The authors thank the following individuals for assistance in preparation of this manuscript: Atsushi Nakajima, M.D., Ph.D., Division of Gastroenterology, Yokohama City University Graduate School of Medicine; Kyoko Sakai, M.D., Yutaka Inada, M.D., Akitoshi Douhara, M.D., Tasuku Hara, M.D., Center for Digestive and Liver Diseases, Nara City Hospital; Tomokazu Ishitobi, M.D., Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University; Yoshihiro Kamada, M.D., Ph.D., Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine; Takaaki Ohtake, M.D., Ph.D., Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa; Yoshito Itoh, M.D., Ph.D., Toshikazu Yoshikawa, M.D., Ph.D., Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine.
Conflicts of interest
The authors have no conflicts of interest to disclose.
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