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Noninvasive scoring systems in patients with nonalcoholic fatty liver disease with normal alanine aminotransferase levels

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

The severity of liver fibrosis must be estimated to determine the prognosis, for surveillance, and for optimal treatment of nonalcoholic fatty liver disease (NAFLD). However, the severity of hepatic fibrosis tends to be underestimated in patients with normal ALT.

Methods

We investigated histological data and scoring systems (FIB-4 index, NAFLD fibrosis score, BARD score, and AST/ALT ratio) of 1,102 liver-biopsy-confirmed NAFLD patients.

Results

A total of 235 NAFLD patients with normal ALT were estimated to exist. The ratio of advanced fibrosis (stage 3–4) was seen in 16.1 % of subjects with normal ALT. Scoring systems, especially the FIB-4 index and NAFLD fibrosis score, were clinically very useful (AUROC >0.8), even in patients with normal ALT. Furthermore, with resetting of the cutoff values, the FIB-4 index (>1.659) and NAFLD fibrosis score (>0.735) were found to have a higher sensitivity and higher specificity for the prediction of advanced fibrosis, and all of these scoring systems (FIB-4 index, NAFLD fibrosis score, BARD score, and AST/ALT ratio) had higher negative predictive values (>90.3 %). By using the resetting cutoff value, liver biopsy could have been avoided in 60.4 % (FIB-4), 66.4 % (NAFLD fibrosis score), 51.9 % (BARD score), and 62.1 % (AST/ALT ratio).

Conclusions

We reset the cutoff values of numerous non-invasive scoring systems to improve their clinical usefulness in the prediction of liver fibrosis in NAFLD patients with normal ALT, and these non-invasive scoring systems with the reset cutoff values could be of substantial benefit to reduce the number of liver biopsies performed.

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Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

AUROC:

Area under the receiver-operating characteristic curve

BMI:

Body mass index

LDL:

Low-density lipoprotein

HDL:

High-density lipoprotein

NPV:

Negative predictive value

PPV:

Positive predictive value

AAR:

AST/ALT ratio

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Acknowledgments

This work was supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan (22790660 to MY and 22590741 to YE), by a Grant from the Chiyoda Mutual Life Foundation to YS, and by a Thrust Area Research Grand from Osaka City University to HF and NK.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Masato Yoneda, Kento Imajo & Atsushi Nakajima

  2. Division of Hepatology, Saga Medical School, Saga, Japan

    Yuichiro Eguchi, Keizo Anzai & Kazuma Fujimoto

  3. Department of Hepatology, Graduate School of Medicine Osaka City University, Osaka, Japan

    Hideki Fujii

  4. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yoshio Sumida, Yoshito Itoh & Toshikazu Yoshikawa

  5. Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Hideyuki Hyogo & Kazuaki Chayama

  6. Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan

    Masafumi Ono & Toshiji Saibara

  7. Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan

    Yasuaki Suzuki & Yutaka Kohgo

  8. Department of Medicine and Digestive Disease Information and Research, Kurume University School of Medicine, Kurume, Japan

    Takumi Kawaguchi & Michio Sata

  9. School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA

    Noriaki Aoki

  10. Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan

    Kazuyuki Kanemasa

  11. Hepatology Center, Saiseikai Suita Hospital, Suita, Japan

    Takeshi Okanoue

Authors
  1. Masato Yoneda
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  2. Kento Imajo
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  4. Hideki Fujii
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  6. Hideyuki Hyogo
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  7. Masafumi Ono
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  8. Yasuaki Suzuki
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  18. Keizo Anzai
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  19. Kazuma Fujimoto
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  20. Takeshi Okanoue
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  21. Atsushi Nakajima
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Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

Corresponding author

Correspondence to Yuichiro Eguchi.

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Yoneda, M., Imajo, K., Eguchi, Y. et al. Noninvasive scoring systems in patients with nonalcoholic fatty liver disease with normal alanine aminotransferase levels. J Gastroenterol 48, 1051–1060 (2013). https://doi.org/10.1007/s00535-012-0704-y

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  • DOI: https://doi.org/10.1007/s00535-012-0704-y

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