Top

Journal of Gastroenterology

Published in:

01-01-2018 | Original Article―Liver, Pancreas, and Biliary Tract

A simple scoring system using type IV collagen 7S and aspartate aminotransferase for diagnosing nonalcoholic steatohepatitis and related fibrosis

Authors: Takeshi Okanoue, Hayao Ebise, Toshihiro Kai, Masayuki Mizuno, Toshihide Shima, Junji Ichihara, Mikio Aoki

Published in: Journal of Gastroenterology | Issue 1/2018

Abstract

Background

Recently we reported novel noninvasive scoring systems for diagnosing nonalcoholic steatohepatitis (NASH) and related fibrosis, namely FM-NASH index and FM-fibro index. They are highly accurate, however, they contain some items not widely used in clinical practice and require six or more items to diagnose both NASH and related fibrosis. By focusing on widely used items, we tried to identify convenient markers in common with the both diagnoses.

Methods

To explore the markers for NASH and related fibrosis in nonalcoholic fatty liver disease (NAFLD) patients, we used data of 24 clinical items in our previous report. By logistic regression analysis, we identified items suitable for the both diagnoses. We then evaluated their accuracies by area under the receiver operator characteristic curves (AUROCs) on independent validation data.

Results

We identified the combination of type IV collagen 7S and aspartate aminotransferase (AST) as the predictor both for NASH and related fibrosis. We developed a scoring system based on the combination and evaluated the prediction accuracy: the AUROCs for training/validation data sets are 0.857/0.769 for NASH and 0.918/0.842 for NASH-related fibrosis. The former was higher than that of NAFIC score, and the latter was higher than those of existing fibrosis markers: BARD score, FIB-4 index and NAFLD fibrosis score but lower than FM-fibro index.

Conclusions

The scoring system using type IV collagen 7S and AST named CA index can predict both NASH and related fibrosis in NAFLD patients with sufficient accuracy and could be a convenient diagnostic and screening tool for NASH and related fibrosis. The scoring system needs to be validated in independent larger populations from multiple clinical centers.

Available only for authorised users

Weiß J, Rau M, Geier A. Non-alcoholic fatty liver disease: epidemiology, clinical course, investigation, and treatment. Dtsch. Ärzteblatt Int. 2014;111:447–52.

Sayiner M, Koenig A, Henry L, et al. Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in the United States and the rest of the world. Clin Liver Dis. 2016;20:205–14.CrossRefPubMed

Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(389–397):e10.

Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–9.CrossRefPubMed

Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol. 2014;20:475–85.CrossRefPubMedPubMedCentral

Fitzpatrick E, Dhawan A. Noninvasive biomarkers in non-alcoholic fatty liver disease: current status and a glimpse of the future. World J Gastroenterol. 2014;20:10851–63.CrossRefPubMedPubMedCentral

Bedossa P, Patel K. Biopsy and noninvasive methods to assess progression of nonalcoholic fatty liver disease. Gastroenterology. 2016;150:1811–22.CrossRefPubMed

Yoshimura K, Okanoue T, Ebise H, et al. Identification of novel noninvasive markers for diagnosing nonalcoholic steatohepatitis and related fibrosis by data mining. Hepatology. 2016;63:462–73.CrossRefPubMed

Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.CrossRefPubMed

10.

Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.CrossRefPubMed

11.

Pencina MJ, D’Agostino RB, D’Agostino RB, et al. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157–72.CrossRefPubMed

12.

Pencina MJ, D’Agostino RB, Steyerberg EW. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011;30:11–21.CrossRefPubMed

13.

Pickering JW, Endre ZH. New metrics for assessing diagnostic potential of candidate biomarkers. Clin J Am Soc Nephrol. 2012;7:1355–64.CrossRefPubMed

14.

Sumida Y, Kanemasa K, Douhara A, et al. A proposal of simple scoring system to differentiate nonalcoholic steatohepatitis from nonalcoholic fatty liver disease: we originally named NAFIC score composed of serum ferritin, fasting insulin, type IV collagen 7S. Kanzo. 2008;49:279–81.CrossRef

15.

Sumida Y, Yoneda M, Hyogo H, et al. A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46:257–68.CrossRefPubMed

16.

Harrison SA, Oliver D, Arnold HL, et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57:1441–7.CrossRefPubMed

17.

Fujii H, Enomoto M, Fukushima W, et al. Applicability of BARD score to Japanese patients with NAFLD. Gut. 2009;58:1566–7.CrossRefPubMed

18.

Raszeja-Wyszomirska J, Szymanik B, Ławniczak M, et al. Validation of the BARD scoring system in Polish patients with nonalcoholic fatty liver disease (NAFLD). BMC Gastroenterol. 2010;10:67.CrossRefPubMedPubMedCentral

19.

Ruffillo G, Fassio E, Alvarez E, et al. Comparison of NAFLD fibrosis score and BARD score in predicting fibrosis in nonalcoholic fatty liver disease. J Hepatol. 2011;54:160–3.CrossRefPubMed

20.

Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7:1104–12.CrossRefPubMedPubMedCentral

21.

Sumida Y, Yoneda M, Hyogo H, et al. Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol. 2012;12:2.CrossRefPubMedPubMedCentral

22.

Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.CrossRefPubMed

23.

Qureshi K, Clements RH, Abrams GA. The utility of the “NAFLD fibrosis score” in morbidly obese subjects with NAFLD. Obes Surg. 2008;18:264–70.CrossRefPubMed

24.

Wong VWS, Wong GLH, Chim AML, et al. Validation of the NAFLD fibrosis score in a Chinese population with low prevalence of advanced fibrosis. Am J Gastroenterol. 2008;103:1682–8.CrossRefPubMed

25.

Risteli J, Bächinger HP, Engel J, et al. 7-S collagen: characterization of an unusual basement membrane structure. Eur J Biochem. 1980;108:239–50.CrossRefPubMed

26.

Fukutomi T, Sakamoto S, Isobe H, et al. Clinical significance of the serum levels of the 7S domain of type IV collagen in patients with primary biliary cirrhosis. J Gastroenterol Hepatol. 1992;7:596–601.CrossRefPubMed

27.

Matsuzaki Y, Yoshiga S, Sugitani T, et al. Enzyme immunoassay of serum type IV collagen in anti-HCV positive chronic liver diseases. Clin Chim Acta. 1993;221:209–17.CrossRefPubMed

28.

Tsutsumi M, Takase S, Urashima S, et al. Serum markers for hepatic fibrosis in alcoholic liver disease: which is the best marker, Type III procollagen, type IV collagen, laminin, tissue inhibitor of metalloproteinase, or prolyl hydroxylase? Alcohol Clin Exp Res. 1996;20:1512–7.CrossRefPubMed

29.

Sakugawa H, Nakayoshi T, Kobashigawa K, et al. Clinical usefulness of biochemical markers of liver fibrosis in patients with nonalcoholic fatty liver disease. World J Gastroenterol. 2005;11:255–9.CrossRefPubMedPubMedCentral

30.

Shimada M, Kawahara H, Ozaki K, et al. Usefulness of a combined evaluation of the serum adiponectin level, HOMA-IR, and serum type IV collagen 7S level to predict the early stage of nonalcoholic steatohepatitis. Am J Gastroenterol. 2007;102:1931–8.CrossRefPubMed

31.

Yoneda M, Mawatari H, Fujita K, et al. Type IV collagen 7s domain is an independent clinical marker of the severity of fibrosis in patients with nonalcoholic steatohepatitis before the cirrhotic stage. J Gastroenterol. 2007;42:375–81.CrossRefPubMed

32.

Mizuno M, Shima T, Oya H, et al. Classification of patients with nonalcoholic fatty liver disease using rapid immunoassay of serum type IV collagen compared with that using liver histology and other fibrosis markers. Hepatol. Res. 2016;47:1–10.

33.

Prieto J, Barry M, Sherlock S. Serum ferritin in patients with iron overload and with acute and chronic liver diseases. Gastroenterology. 1975;68:525–33.PubMed

34.

Watanabe S, Hashimoto E, Ikejima K, et al. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. J Gastroenterol. 2015;50:364–77.CrossRefPubMed

Title: A simple scoring system using type IV collagen 7S and aspartate aminotransferase for diagnosing nonalcoholic steatohepatitis and related fibrosis
Authors: Takeshi Okanoue
Hayao Ebise
Toshihiro Kai
Masayuki Mizuno
Toshihide Shima
Junji Ichihara
Mikio Aoki
Publication date: 01-01-2018
Publisher: Springer Japan
Published in: Journal of Gastroenterology / Issue 1/2018
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI: https://doi.org/10.1007/s00535-017-1355-9

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

A simple scoring system using type IV collagen 7S and aspartate aminotransferase for diagnosing nonalcoholic steatohepatitis and related fibrosis

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Serum HMGB1 concentrations at 4 weeks is a useful predictor of extreme poor prognosis for advanced hepatocellular carcinoma treated with sorafenib and hepatic arterial infusion chemotherapy

Effects of canagliflozin, an SGLT2 inhibitor, on hepatic function in Japanese patients with type 2 diabetes mellitus: pooled and subgroup analyses of clinical trials

Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth

Erratum to: Serum HMGB1 concentrations at 4 weeks is a useful predictor of extreme poor prognosis for advanced hepatocellular carcinoma treated with sorafenib and hepatic arterial infusion chemotherapy

Modifiable factors and esophageal cancer: a systematic review of published meta-analyses

Virological and Clinical Characteristics of Hepatitis B Virus Genotype A

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page