RT Journal Article
T1 acNASH index to diagnose nonalcoholic steatohepatitis: a prospective derivation and global validation study.
A1 Wu, Xi-Xi
A1 Zheng, Kenneth I
A1 Boursier, Jerome
A1 Wah-Kheong, Chan
A1 Yilmaz, Yusuf
A1 Romero-Gomez, Manuel
A1 El-Kassas, Mohamed
A1 Targher, Giovanni
A1 Byrne, Christopher D
A1 Huang, Zhi-Ming
A1 Zheng, Ming-Hua
K1 ALT, alanine aminotransferase
K1 AST, aspartate aminotransferase
K1 AUROC, area under receiver operating characteristics
K1 BMI, body mass index
K1 CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration
K1 CRN, Clinical Research Network
K1 GAA, guanidine-acetic acid
K1 HBV, chronic viral hepatitis B
K1 HCV, chronic viral hepatitis C
K1 NAFLD, nonalcoholic fatty liver disease
K1 NAS, NAFLD Activity Score
K1 NASH, nonalcoholic steatohepatitis
K1 NPV, negative predictive value
K1 Nonalcoholic steatohepatitis
K1 PERSONS, Prospective Epidemic Research Specifically Of NASH
K1 PPV, positive predictive value
K1 SCr, serum creatinine
K1 Se, sensitivity
K1 Sp, specificity
K1 T2DM, type 2 diabetes mellitus
K1 e-GFR, estimated glomerular filtration rate
K1 metabolic dysfunction-associated fatty liver disease
K1 nonalcoholic fatty liver disease
K1 primary care
K1 scoring system
K1 screening
AB There is an unmet need for non-invasive biomarkers for the diagnosis of nonalcoholic steatohepatitis (NASH) in non-specialized settings. We aimed to develop and validate a non-invasive test for diagnosing NASH in individuals with biopsy-proven nonalcoholic fatty liver disease (NAFLD). We developed a non-invasive test named the acNASH index that combines serum creatinine and aspartate aminotransferase levels in a derivation cohort of 390 Chinese NAFLD patients admitted to the hepatology center of the First Affiliated Hospital of Wenzhou Medical University (China) between December 2016 and September 2019 and subsequently validated in five external cohorts of different ethnicities of patients with biopsy-confirmed NAFLD (pooled n=1,089). The performance of the acNASH index for identifying NASH (defined as NAFLD activity score ≥5 with score of ≥1 for each steatosis, lobular inflammation and ballooning) was good in the derivation cohort with an area under receiver operating characteristics (AUROC) of 0·818 (95%CI 0·777-0·860). A cutoff of acNASH index 7·73 gave a Sp of 91%, Se of 53% and a positive predictive value (PPV) of 85% for ruling-in NASH. In the pooled validation cohort (n=1,089), the diagnostic performance of the index was also good with AUROC=0·805 (95%CI 0·780-0·830), NPV of 93% for ruling-out NASH and PPV of 73% for ruling-in NASH. Subgroup analyses showed similar performance in patients with diabetes or subjects with normal serum transaminase levels. The acNASH index shows promising utility as a simple non-invasive biomarker for diagnosing NASH among adults with biopsy-proven NAFLD of different ethnicities from different countries. 
PB The Lancet Publishing Group
YR 2021
FD 2021-10-01
LK https://hdl.handle.net/10668/27477
UL https://hdl.handle.net/10668/27477
LA en
NO Wu XX, Zheng KI, Boursier J, Chan WK, Yilmaz Y, Romero-Gómez M, et al. acNASH index to diagnose nonalcoholic steatohepatitis: a prospective derivation and global validation study. EClinicalMedicine. 2021 Oct 1;41:101145.
DS RISalud
RD Apr 7, 2025