Discrimination of Nonalcoholic Steatohepatitis Using Transient Elastography in Patients with Nonalcoholic Fatty Liver Disease

<div><p>Background/aims</p><p>The accuracy of noninvasive markers to discriminate nonalcoholic steatohepatitis (NASH) is unsatisfactory. We investigated whether transient elastography (TE) could discriminate patients with NASH from those with nonalcoholic fatty liver disease (NAFLD).</p><p>Methods</p><p>The patients suspected of NAFLD who underwent liver biopsy and concomitant TE were recruited from five tertiary centers between November 2011 and December 2013.</p><p>Results</p><p>The study population (n = 183) exhibited a mean age of 40.6 years and male predominance (n = 111, 60.7%). Of the study participants, 89 (48.6%) had non-NASH and 94 (51.4%) had NASH. The controlled attenuation parameter (CAP) and liver stiffness (LS) were significantly correlated with the degrees of steatosis (r = 0.656, <i>P</i><0.001) and fibrosis (r = 0.714, <i>P</i><0.001), respectively. The optimal cut-off values for steatosis were 247 dB/m for S1, 280 dB/m for S2, and 300 dB/m for S3. Based on the independent predictors derived from multivariate analysis [<i>P</i> = 0.044, odds ratio (OR) 4.133, 95% confidence interval (CI) 1.037–16.470 for <u><i>C</i></u>AP>250 dB/m; <i>P</i> = 0.013, OR 3.399, 95% CI 1.295–8.291 for <u><i>L</i></u>S>7.0 kPa; and <i>P</i><0.001, OR 7.557, 95% CI 2.997–19.059 for <u><i>A</i></u>lanine aminotransferase>60 IU/L], we developed a novel CLA model for discriminating patients with NASH. The CLA model showed good discriminatory capability, with an area under the receiver operating characteristic curve (AUROC) of 0.812 (95% CI 0.724–0.880). To assess discriminatory power, the AUROCs, as determined by the bootstrap method, remained largely unchanged between iterations, with an average value of 0.833 (95% CI 0.740–0.893).</p><p>Conclusion</p><p>This novel TE-based CLA model showed acceptable accuracy in discriminating NASH from simple steatosis. However, further studies are required for external validation.</p></div

Diagnostic performance of LS for assessing liver fibrosis in patients with NAFLD

<p>Diagnostic performance of LS for assessing liver fibrosis in patients with NAFLD</p

The distribution of LS and CAP values according to histologic fibrosis and steatosis grade.

<p>The bar lines mean the range of each grade of steatosis and fibrosis. LS, liver stiffness; CAP, controlled attenuation parameter.</p

CLA score and corresponding NASH prevalence.

<p>CLA score and corresponding NASH prevalence.</p