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