Combined and sequential non-invasive approach to diagnosing non-alcoholic steatohepatitis in patients with non-alcoholic fatty liver disease and persistently normal alanine aminotransferase levels. Issue 1 (4th March 2020)

• Record Type: Journal Article
• Authors: Zheng, Kenneth I; Liu, Wen-Yue; Pan, Xiao-Yan; Ma, Hong-Lei; Zhu, Pei-Wu; Wu, Xi-Xi; Targher, Giovanni; Byrne, Christopher; Wang, Xiao-Dong; Chen, Yong-Ping; Lu, Fengmin; Zheng, Ming-Hua
• Is Part Of: BMJ open diabetes research and care. Volume 8:Issue 1(2020)
• Publication Date: 2020-03-04
• Subjects: liver disease -- nonalcoholic steatohepatitis -- NAFLD -- diagnosis; Diabetes -- Periodicals; 616.462005
• DOI: 10.1136/bmjdrc-2020-001174
• Languages: English
• ISSNs: 2052-4897

Abstract

Abstract : Background and aim: Imaging-confirmed non-alcoholic fatty liver disease (NAFLD) with normal alanine aminotransferase (nALT) levels is infrequently the subject for further evaluation. Early diagnosis of non-alcoholic steatohepatitis (NASH) is needed to prevent disease progression. Thus, we tested the clinical utility of serum Golgi protein 73 (GP73) levels and developed a new non-invasive score to diagnose NASH in patients with biopsy-confirmed NAFLD and persistent nALT levels. Methods: Serum GP73 and cytokeratin-18 M30 fragments (CK18-M30) levels were measured in 345 patients with biopsy-proven NAFLD. We developed a new score, named G-NASH model (by incorporating serum GP73), and combined it with serum CK18-M30 measurement in a sequential non-invasive approach to accurately identify NASH among patients with NAFLD and persistent nALT levels. Results: 105 (30.4%) patients had persistent nALT, 53 of whom had histologically confirmed NASH. Both serum GP73 and CK18-M30 levels alone had poor diagnostic accuracy in identifying NASH (55.2% and 51.6%, respectively) in these patients. Conversely, G-NASH model performed better than other established non-invasive scoring systems, and by using our proposed sequential non-invasive approach 82.9% of patients with NASH were correctly identified. Conclusions: NASH is highly prevalent in patients with NAFLD with persistent nALT levels. The G-NASH model accurately identifies NASH in this patient group.