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

 Hye Won Lee  ;  Soo Young Park  ;  Seung Up Kim  ;  Jae Young Jang  ;  Hana Park  ;  Ja Kyung Kim  ;  Chun Kyon Lee  ;  Young Eun Chon  ;  Kwang-Hyub Han 
 PLoS One, Vol.11(6) : e0157358, 2016 
Journal Title
 PLoS One 
Issue Date
Adult ; Elasticity Imaging Techniques/methods* ; Fatty Liver/diagnostic imaging* ; Female ; Humans ; Liver/diagnostic imaging* ; Liver Cirrhosis/diagnostic imaging ; Male ; Middle Aged ; Multivariate Analysis ; Non-alcoholic Fatty Liver Disease/diagnostic imaging* ; Odds Ratio ; Predictive Value of Tests
BACKGROUND/AIMS: 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). METHODS: The patients suspected of NAFLD who underwent liver biopsy and concomitant TE were recruited from five tertiary centers between November 2011 and December 2013. RESULTS: 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, P<0.001) and fibrosis (r = 0.714, P<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 [P = 0.044, odds ratio (OR) 4.133, 95% confidence interval (CI) 1.037-16.470 for CAP>250 dB/m; P = 0.013, OR 3.399, 95% CI 1.295-8.291 for LS>7.0 kPa; and P<0.001, OR 7.557, 95% CI 2.997-19.059 for Alanine 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). CONCLUSION: This novel TE-based CLA model showed acceptable accuracy in discriminating NASH from simple steatosis. However, further studies are required for external validation.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김승업(Kim, Seung Up) ORCID logo https://orcid.org/0000-0002-9658-8050
김자경(Kim, Ja Kyung) ORCID logo https://orcid.org/0000-0001-5025-6846
전영은(Chon, Young Eun)
한광협(Han, Kwang-Hyub) ORCID logo https://orcid.org/0000-0003-3960-6539
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