A New Composite Model including metabolic syndrome, Alanine aminotransferase and Cytokeratin-18 for the Diagnosis of Non-Alcoholic Steatohepatitis in Morbidly Obese Patients

Rodolphe Anty (1) , Antonio Iannelli (2, 3) , Stéphanie Patouraux (2, 3) , Stephanie Bonnafous (2, 3) , Vanessa Lavallard (2, 3) , Massimo Senni-Buratti (2) , Imed Ben Amor (2) , Aline Myx-Staccini (2) , Marie-Christine Saint-Paul , Frédéric Berthier (4) , Pierre-Michel Huet (2) , Yannick Le Marchand-Brustel (2) , Jean Gugenheim (2) , Philippe Gual (2) , Albert Tran (2)

1 Inserm U895, équipe 8
2 Pôle Digestif
3 C3M - Centre méditérannéen de médecine moléculaire
4 Service d'information Médicale

Background and aims: Non invasive approaches are useful to differentiate simple steatosis from non-alcoholic steatohepatitis (NASH) in obese and morbidly obese patients. The aim of this study was to develop a new scoring system to diagnose definitive NASH. Methods: Preoperative clinical and biological data including serum caspase 3-generated cytokeratin-18 fragments (CK18) and peroperative liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group (n=310) and validation group (n=154). Definitive NASH was defined according to Kleiner's classification with a NAFLD Activity Score (NAS) ≥5. Results: Alanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome (MS) were independent predictors for discriminating patients with NAS ≥5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS ≥5. Whereas serum CK18 fragment alone had an Area under the Receiver Operating Characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training and in the validation group respectively. Conclusion: A simple and non invasive composite model including MS, ALT and CK18 fragments was able to accurately predict NAS ≥5 in morbidly obese subjects.

Mots clés: fatty liver; Alanine Aminotransferase; Metabolic syndrome; Cytokeratin-18 fragment levels; scoring system

Rodolphe Anty, Antonio Iannelli, Stéphanie Patouraux, Stephanie Bonnafous, Vanessa Lavallard, et al.. A New Composite Model including metabolic syndrome, Alanine aminotransferase and Cytokeratin-18 for the Diagnosis of Non-Alcoholic Steatohepatitis in Morbidly Obese Patients. Alimentary Pharmacology and Therapeutics, 2010, 32 (11-12), pp.1315. ⟨10.1111/j.1365-2036.2010.04480.x⟩. ⟨hal-00583896⟩