Wu, Xi-XiZheng, Kenneth IBoursier, JeromeWah-Kheong, ChanYilmaz, YusufRomero-Gomez, ManuelEl-Kassas, MohamedTargher, GiovanniByrne, Christopher DHuang, Zhi-MingZheng, Ming-Hua2025-01-072025-01-072021-10-01Wu 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.https://hdl.handle.net/10668/27477There 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.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/ALT, alanine aminotransferaseAST, aspartate aminotransferaseAUROC, area under receiver operating characteristicsBMI, body mass indexCKD-EPI, Chronic Kidney Disease Epidemiology CollaborationCRN, Clinical Research NetworkGAA, guanidine-acetic acidHBV, chronic viral hepatitis BHCV, chronic viral hepatitis CNAFLD, nonalcoholic fatty liver diseaseNAS, NAFLD Activity ScoreNASH, nonalcoholic steatohepatitisNPV, negative predictive valueNonalcoholic steatohepatitisPERSONS, Prospective Epidemic Research Specifically Of NASHPPV, positive predictive valueSCr, serum creatinineSe, sensitivitySp, specificityT2DM, type 2 diabetes mellituse-GFR, estimated glomerular filtration ratemetabolic dysfunction-associated fatty liver diseasenonalcoholic fatty liver diseaseprimary carescoring systemscreeningNon-alcoholic Fatty Liver DiseasePredictive Value of TestsCreatinineROC CurveDiabetes MellitusAspartate AminotransferasesBiopsyInflammationBiomarkersresearch article34646997open accessEnfermedad del hígado graso no alcohólicoBiopsiaBiomarcadoresPueblos del este de AsiaDiagnósticoInflamaciónCurva ROCAspartato AminotransferasasCreatininaTransaminasas10.1016/j.eclinm.2021.1011452589-5370PMC8495106http://www.thelancet.com/article/S2589537021004259/pdfhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8495106/pdf