Obesity Surgery

, Volume 21, Issue 4, pp 431–439 | Cite as

A Biomarker Panel for Non-alcoholic Steatohepatitis (NASH) and NASH-Related Fibrosis

  • Zobair M. YounossiEmail author
  • Sandra Page
  • Nila Rafiq
  • Aybike Birerdinc
  • Maria Stepanova
  • Noreen Hossain
  • Arian Afendy
  • Zahra Younoszai
  • Zachary Goodman
  • Ancha Baranova
Clinical Research



Patients with biopsy-proven NASH and especially those with fibrosis are at risk for progressive liver disease, emphasizing the clinical importance of developing non-invasive biomarkers for NASH and NASH-related fibrosis.


This study examines the performance of a new biomarker panel for NASH and NASH-related fibrosis with a combination of clinical and laboratory variables.


Enrolled patients had biopsy-proven NAFLD. Clinical data, laboratory data, and serum samples were collected at the time of biopsy. Fasting serum was assayed for adiponectin, resistin, glucose, M30, M65, Tissue inhibitor of metalloproteinases-1 (Timp-1), ProCollagen 3 N-terminal peptide (PIIINP), and hyaluronic acid (HA). Regression models predictive of NASH, NASH-related fibrosis, and NASH-related advanced fibrosis were designed and cross-validated.


Of the 79 enrolled NAFLD patients, 40 had biopsy-proven NASH and 39 had non-NASH NAFLD. Clinical and laboratory data were from this cohort were used to develop a NAFLD Diagnostic Panel that includes three models (models for NASH, NASH-related fibrosis, and NASH-related advanced fibrosis). The model for predicting NASH includes diabetes, gender, BMI, triglycerides, M30 (apoptosis), and M65–M30 (necrosis) [AUC: 0.81, 95% CI, 0.70–0.89, 300 p value <9E 301 −06]. The NASH-related fibrosis prediction model includes the same predictors [AUC: 0.80, 95% CI 0.68–0.88, 307 p value <0.00014]. Finally, the NASH-related advanced fibrosis model includes type 2 diabetes, serum triglycerides, Timp-1, and AST [AUC: 0.81, 95% CI, 0.70–0.89; p value, 0.000062].


This NAFLD Diagnostic Panel based on a clinical and laboratory data has good performance characteristics and is easy to use. This biomarker panel could become useful in the management of patients with NAFLD.


NASH Hepatic fibrosis Biomarkers 



This study has been supported by the Liver Disease Outcomes Fund of the Center for Liver Diseases at Inova Fairfax Hospital, Inova Health system. The authors acknowledge Dr. Stig Linder and Peviva, Bromma, Sweden for providing kits for M-30 and M-65.


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Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Zobair M. Younossi
    • 1
    • 2
    • 3
    Email author
  • Sandra Page
    • 2
    • 3
  • Nila Rafiq
    • 1
    • 2
  • Aybike Birerdinc
    • 2
    • 3
  • Maria Stepanova
    • 1
    • 2
  • Noreen Hossain
    • 2
  • Arian Afendy
    • 1
    • 2
  • Zahra Younoszai
    • 1
    • 2
  • Zachary Goodman
    • 1
  • Ancha Baranova
    • 1
    • 2
    • 3
  1. 1.Center for Liver DiseasesInova Fairfax HospitalFalls ChurchUSA
  2. 2.Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchUSA
  3. 3.Center for the Study of Genomics in Liver Diseases, Molecular and Microbiology DepartmentGeorge Mason UniversityFairfaxUSA

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