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A Noninvasive Clinical Scoring Model Predicts Risk of Nonalcoholic Steatohepatitis in Morbidly Obese Patients

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Abstract

Background

A simple model to predict nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease is desirable to optimize the selection of patients for liver biopsy. We investigated a large group of morbidly obese patients to derive a scoring system based on simple clinical and laboratory variables.

Methods

Consecutive subjects undergoing bariatric surgery and without evidence of other liver disease or significant alcohol use underwent intraoperative liver biopsy. Demographic, clinical, and biochemical variables were collected. A scoring model was derived using variables found to be independent predictors of NASH. The scores were divided into four risk categories (low, intermediate, high, and very high). Positive and negative predictive values (PPV/NPV) were derived for each category and the area under the receiver operator curve (AUROC) was calculated.

Results

A total of 253 subjects were included: 52 (20.6%) had NASH, 116 (45.8%) had simple steatosis, and 85 (33.6%) had normal liver histology. Only ten subjects (19% of NASH group) had significant (≥ stage 2) fibrosis. Multivariate analysis identified diabetes, abnormal ALT, and hypertriglyceridemia as independent predictors of NASH. Sleep apnea showed a strong trend toward significance and was also included in the model. This model showed a NPV of 89.7% in the low risk category and a PPV of 75% in the very high risk category, with AUROC of 0.76.

Conclusions

A simple scoring system performs well in predicting NASH and can be used in the clinic to optimize the selection of morbidly obese patients for liver biopsy.

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References

  1. Charlton M. Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol. 2004;2(12):1048–58.

    Article  PubMed  Google Scholar 

  2. Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28(4):339–50.

    Article  PubMed  Google Scholar 

  3. Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413–9.

    Article  CAS  PubMed  Google Scholar 

  4. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346(16):1221–31.

    Article  CAS  PubMed  Google Scholar 

  5. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123(1):134–40.

    Article  PubMed  Google Scholar 

  6. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344(7):495–500.

    Article  CAS  PubMed  Google Scholar 

  7. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37(4):917–23.

    Article  PubMed  Google Scholar 

  8. Dixon JB, Bhathal PS, O'Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121(1):91–100.

    Article  CAS  PubMed  Google Scholar 

  9. Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15(3):310–5.

    Article  PubMed  Google Scholar 

  10. Spaulding L, Trainer T, Janiec D. Prevalence of non-alcoholic steatohepatitis in morbidly obese subjects undergoing gastric bypass. Obes Surg. 2003;13(3):347–9.

    Article  PubMed  Google Scholar 

  11. Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.

    Article  PubMed  Google Scholar 

  12. Campos GM, Bambha K, Vittinghoff E, et al. A clinical scoring system for predicting nonalcoholic steatohepatitis in morbidly obese patients. Hepatology. 2008;47(6):1916–23.

    Article  PubMed  Google Scholar 

  13. Harnois F, Msika S, Sabate JM, et al. Prevalence and predictive factors of non-alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery. Obes Surg. 2006;16(2):183–8.

    Article  PubMed  Google Scholar 

  14. Wong VW, Wong GL, Tsang SW, et al. Metabolic and histological features of non-alcoholic fatty liver disease patients with different serum alanine aminotransferase levels. Aliment Pharmacol Ther. 2009;29(4):387–96.

    Article  CAS  PubMed  Google Scholar 

  15. Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48(3):792–8.

    Article  CAS  PubMed  Google Scholar 

  16. Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol. 1999;94(4):1018–22.

    Article  CAS  PubMed  Google Scholar 

  17. Angulo P, Keach JC, Batts KP, et al. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30(6):1356–62.

    Article  CAS  PubMed  Google Scholar 

  18. Hossain N, Afendy A, Stepanova M, et al. Independent predictors of fibrosis in patients with non-alcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009 Jun;7:1224–9.

    Article  CAS  PubMed  Google Scholar 

  19. Amarapurka DN, Amarapurkar AD, Patel ND, et al. Nonalcoholic steatohepatitis (NASH) with diabetes: predictors of liver fibrosis. Ann Hepatol. 2006;5(1):30–3.

    CAS  PubMed  Google Scholar 

  20. Gholam PM, Flancbaum L, Machan JT, et al. Nonalcoholic fatty liver disease in severely obese subjects. Am J Gastroenterol. 2007;102(2):399–408.

    Article  CAS  PubMed  Google Scholar 

  21. Abrams GA, Kunde SS, Lazenby AJ, et al. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatology. 2004;40(2):475–83.

    Article  PubMed  Google Scholar 

  22. Kallwitz ER, Guzman G, TenCate V, et al. The histologic spectrum of liver disease in African-American, non-Hispanic White, and Hispanic obesity surgery patients. Am J Gastroenterol. 2009;104(1):64–9.

    Article  PubMed  Google Scholar 

  23. Sorrentino P, Tarantino G, Conca P, et al. Silent non-alcoholic fatty liver disease—a clinical-histological study. J Hepatol. 2004;41(5):751–7.

    Article  CAS  PubMed  Google Scholar 

  24. Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol. 2006;40 Suppl 1:S5–10.

    PubMed  Google Scholar 

  25. Younossi ZM, Gramlich T, Matteoni CA, et al. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol. 2004;2(3):262–5.

    Article  PubMed  Google Scholar 

  26. Brunt EM, Kleiner DE, Wilson LA, et al. Portal chronic inflammation in nonalcoholic fatty liver disease (NAFLD): a histologic marker of advanced NAFLD-clinicopathologic correlations from the nonalcoholic steatohepatitis clinical research network. Hepatology. 2009;49(3):809–20.

    Article  PubMed  Google Scholar 

  27. Friis-Liby I, Aldenborg F, Jerlstad P, et al. High prevalence of metabolic complications in patients with non-alcoholic fatty liver disease. Scand J Gastroenterol. 2004;39(9):864–9.

    Article  CAS  PubMed  Google Scholar 

  28. Sung KC, Ryan MC, Wilson AM. The severity of nonalcoholic fatty liver disease is associated with increased cardiovascular risk in a large cohort of non-obese Asian subjects. Atherosclerosis. 2009;203(2):581–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Pathology, Department of Pathology, Medial College of Wisconsin, Milwaukee, WI, USA

    Richard Komorowski

  2. Department of Surgery, Medial College of Wisconsin, Milwaukee, WI, USA

    James Wallace

  3. Zabocki VA Medical Center, Milwaukee, WI, USA

    Samer Gawrieh

  4. Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Alex Ulitsky, Ashwin N. Ananthakrishnan, Sri Naveen Surapaneni, Jose Franco, Kia Saeian & Samer Gawrieh

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  1. Alex Ulitsky
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  2. Ashwin N. Ananthakrishnan
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  3. Richard Komorowski
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  4. James Wallace
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  5. Sri Naveen Surapaneni
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  6. Jose Franco
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  7. Kia Saeian
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  8. Samer Gawrieh
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Correspondence to Samer Gawrieh.

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Ulitsky, A., Ananthakrishnan, A.N., Komorowski, R. et al. A Noninvasive Clinical Scoring Model Predicts Risk of Nonalcoholic Steatohepatitis in Morbidly Obese Patients. OBES SURG 20, 685–691 (2010). https://doi.org/10.1007/s11695-010-0118-y

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  • DOI: https://doi.org/10.1007/s11695-010-0118-y

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