Predictive factors for nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD).

AIMS The aim of our study was to assess the clinical and biological parameters associated with Nonalcoholic steatohepatitis (NASH) and to establish the predictors of significant fibrosis in Nonalcoholic fatty liver disease (NAFLD) patients. METHODS We correlated clinical and biochemical parameters with histological features (simple steatosis or steatohepatitis) in 97 patients with NAFLD admitted to the University Hospital Bucharest for persistently raised aminotransferase levels. The biochemical parameters included lipid profile, glucose, liver tests and insulin. The Homeostatic Metabolic Assesment (HOMA)-index and the oxidative stress were also evaluated. Factors associated with NASH and severe fibrosis (F≥=3) were identified using the Mann-Whitney U test and multivariate analysis. The overall validity was measured using the area under receiver operating characteristic curve (AUROC) with 95% CI. RESULTS At univariate analysis, age, BMI, splenic longitudinal diameter (SLD), HOMA, gamma glutamyl transpeptidase, C- reactive protein (CRP), albumin and INR were significantly associated with histologically proven NASH. The multivariate analysis identified four independent predictive factors for the presence of NASH: CRP (p=0.004), SLD (p=0.018), HOMA (p=0.03) and albumin level (p=0.041). The variables independently associated with severe fibrosis were albumin (p=0.008), blood glucose (p=0.017) and BMI (p=0.048). CONCLUSION A predictive model that incorporates the clinical and biological parameters may identify at-risk patients with NAFLD, avoiding liver biopsy on a routine basis.