Journal of Gastroenterology

, Volume 46, Issue 2, pp 257–268

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

  • Yoshio Sumida
  • Masato Yoneda
  • Hideyuki Hyogo
  • Kanji Yamaguchi
  • Masafumi Ono
  • Hideki Fujii
  • Yuichiro Eguchi
  • Yasuaki Suzuki
  • Shunsuke Imai
  • Kazuyuki Kanemasa
  • Koji Fujita
  • Kazuaki Chayama
  • Kohichiroh Yasui
  • Toshiji Saibara
  • Norifumi Kawada
  • Kazuma Fujimoto
  • Yutaka Kohgo
  • Takeshi Okanoue
  • Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)
Original Article—Liver, Pancreas, and Biliary Tract

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 

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Copyright information

© Springer 2010

Authors and Affiliations

  • Yoshio Sumida
    • 1
  • Masato Yoneda
    • 2
  • Hideyuki Hyogo
    • 3
  • Kanji Yamaguchi
    • 4
  • Masafumi Ono
    • 5
  • Hideki Fujii
    • 6
  • Yuichiro Eguchi
    • 7
  • Yasuaki Suzuki
    • 8
  • Shunsuke Imai
    • 9
  • Kazuyuki Kanemasa
    • 1
  • Koji Fujita
    • 2
  • Kazuaki Chayama
    • 3
  • Kohichiroh Yasui
    • 4
  • Toshiji Saibara
    • 5
  • Norifumi Kawada
    • 6
  • Kazuma Fujimoto
    • 7
  • Yutaka Kohgo
    • 8
  • Takeshi Okanoue
    • 10
  • Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)
  1. 1.Center for Digestive and Liver DiseasesNara City HospitalNaraJapan
  2. 2.Division of GastroenterologyYokohama City University Graduate School of MedicineYokohamaJapan
  3. 3.Department of Medicine and Molecular Science, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  4. 4.Department of Gastroenterology and HepatologyKyoto Prefectural University of MedicineKyotoJapan
  5. 5.Department of Gastroenterology and HepatologyKochi Medical SchoolKochiJapan
  6. 6.Department of Hepatology, Graduate School of MedicineOsaka City UniversityOsakaJapan
  7. 7.Department of Internal Medicine, Saga Medical SchoolSaga UniversitySagaJapan
  8. 8.Division of Gastroenterology and Hematology/Oncology, Department of MedicineAsahikawa Medical CollegeAsahikawaJapan
  9. 9.Department of PathologyNara City HospitalNaraJapan
  10. 10.Hepatology CenterSaiseikai Suita HospitalOsakaJapan

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