Atif Zaman, MD, MPH reviewing Vilar-Gomez E et al. Hepatology 2016 Jun.

An accurate, easy-to-use scoring system shows promise for use in clinical practice.

A common clinical dilemma in management of patients with nonalcoholic steatohepatitis (NASH) is determining when an intervention such as weight loss has been effective without conducting a liver biopsy (the current gold standard to determine NASH resolution).

In a prospective lifestyle intervention trial, researchers identified noninvasive markers of resolution of NASH among 261 patients with biopsy-proven NASH who underwent 52 weeks of scripted recommendations regarding a healthy diet and increased physical activity. Patients underwent a second biopsy at the end of the study period. Using data from 140 patients (derivation group), researchers identified 13 candidate predictors of histologic resolution without worsening of fibrosis, tested them in a model, and validated its performance in 121 patients (validation group).

NASH resolution occurred in 28% and 27% of the derivation and validation groups, respectively. In multivariate analysis, age (odds ratio, 0.89), type 2 diabetes (OR, 0.04), normal alanine aminotransferase level at end of intervention (OR, 9.84), weight loss (OR, 2.75), and a nonalcoholic fatty liver disease activity score ≥5 (OR, 0.08) were independent predictors of NASH resolution. The area under the receiver operating characteristic curve was 0.95–0.96 for both the derivation and validation groups. Using validation group data, a score threshold of ≤46.15 yielded a negative-predictive value of 92% and a score threshold ≥69.72 yielded a positive-predictive value of 89%. A liver biopsy could have been avoided in 88% of the study cohort.

CITATION(S):

Vilar-Gomez E et al. Development and validation of a noninvasive prediction model for nonalcoholic steatohepatitis resolution after lifestyle intervention. Hepatology 2016 Jun; 63:1875. 

JWatch