George Bb Goh1, Danny Issa1,2, Rocio Lopez3, Srinivasan Dasarathy1, Jaividhya Dasarathy4, Ruth Sargent1, Carol Hawkins5, Rish K Pai6, Lisa Yerian6, Amer Khiyami7, Mangesh R Pagadala1, Achuthan Sourianarayanane1, Naim Alkhouri1,8, Arthur J McCullough1. 1. Department of Gastroenterology, Metrohealth Medical Center, Cleveland, Ohio, USA. 2. Department of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, USA. 3. Quantitative Health Services, Metrohealth Medical Center, Cleveland, Ohio, USA. 4. Departments of Family Practice, Cleveland Clinic at the Cleveland Clinic Lerner College of Medicine at Case Western University, Richmond, Virginia, USA. 5. Gastroenterology, Cleveland Clinic at the Cleveland Clinic Lerner College of Medicine at Case Western University, Cleveland, Ohio, USA. 6. Pathology, Metrohealth Medical Center, Richmond, Virginia, USA. 7. Pathology, Metrohealth Medical Center, Cleveland Clinic at the Cleveland Clinic Lerner College of Medicine at Case Western University, Cleveland, Ohio, USA. 8. Pediatric Gastroenterology, Cleveland Clinic at the Cleveland Clinic Lerner College of Medicine at Case Western University, Richmond, Virginia, USA.
Abstract
BACKGROUND: Non-alcoholic steatohepatitis (NASH) is an advanced and aggressive form of non-alcoholic fatty liver disease (NAFLD), which remains difficult to diagnose without a liver biopsy. Hyperferritinemia has increasingly been associated with the presence of NASH. Hence, we sought to explore the relationship between ferritin and NASH and to develop a composite model based on ferritin to predict the presence of NASH. METHODS: A total of 405 patients with biopsy-proven NAFLD were enrolled in the study. Comparison was explored to assess differences between patients with and without NASH, upon which a scoring model was established using variables found to be independent predictors of NASH. RESULTS: Among all patients with NAFLD, 291 (72%) had biopsy-proven NASH, and 114 (28%) had non-NASH. Mean age was 48 ± 12 years, and 56% were female. Ferritin was significantly higher in NASH compared with non-NASH patients (184 vs 126, respectively; P < 0.001) but lacked diagnostic accuracy for predicting NASH alone (area under the curve [AUC 0.62]). The addition of other significant variables such as aspartate aminotransferase, body mass index, platelet count, diabetes, and hypertension to ferritin improved the prediction of NASH with an AUC 0.81 (95% confidence interval: 0.76-0.86). Internal validation of the model using imputed data sets demonstrated that AUC did not change materially. CONCLUSIONS: While higher ferritin was significantly associated with NASH, ferritin alone lacked diagnostic accuracy to predict NASH. However, incorporating several easily obtainable variables with ferritin allowed the construction of a novel scoring system that can be easily applied in the clinical setting to guide management of NAFLD.
BACKGROUND:Non-alcoholic steatohepatitis (NASH) is an advanced and aggressive form of non-alcoholic fatty liver disease (NAFLD), which remains difficult to diagnose without a liver biopsy. Hyperferritinemia has increasingly been associated with the presence of NASH. Hence, we sought to explore the relationship between ferritin and NASH and to develop a composite model based on ferritin to predict the presence of NASH. METHODS: A total of 405 patients with biopsy-proven NAFLD were enrolled in the study. Comparison was explored to assess differences between patients with and without NASH, upon which a scoring model was established using variables found to be independent predictors of NASH. RESULTS: Among all patients with NAFLD, 291 (72%) had biopsy-proven NASH, and 114 (28%) had non-NASH. Mean age was 48 ± 12 years, and 56% were female. Ferritin was significantly higher in NASH compared with non-NASH patients (184 vs 126, respectively; P < 0.001) but lacked diagnostic accuracy for predicting NASH alone (area under the curve [AUC 0.62]). The addition of other significant variables such as aspartate aminotransferase, body mass index, platelet count, diabetes, and hypertension to ferritin improved the prediction of NASH with an AUC 0.81 (95% confidence interval: 0.76-0.86). Internal validation of the model using imputed data sets demonstrated that AUC did not change materially. CONCLUSIONS: While higher ferritin was significantly associated with NASH, ferritin alone lacked diagnostic accuracy to predict NASH. However, incorporating several easily obtainable variables with ferritin allowed the construction of a novel scoring system that can be easily applied in the clinical setting to guide management of NAFLD.
Authors: Thomas Karlas; Lara Weise; Stephanie Kuhn; Felix Krenzien; Matthias Mehdorn; David Petroff; Nicolas Linder; Alexander Schaudinn; Harald Busse; Volker Keim; Johann Pratschke; Johannes Wiegand; Katrin Splith; Moritz Schmelzle Journal: J Transl Med Date: 2017-05-19 Impact factor: 5.531