Other Liver Disease
Value of a two-step approach with cytokeratin-18 and controlled attenuation parameter in noninvasive differential diagnosis of nonalcoholic steatohepatitis
Feng Shen, Ruidan Zheng, Yuqiang Mi, Junping Shi, Xiaoying Wang, Xiqi Hu, Qin Pan, Leiming Xu, Jiangao Fan
Published 2016-06-20
Cite as Chin J Hepatol, 2016, 24(6): 429-434. DOI: 10.3760/cma.j.issn.1007-3418.2016.06.007
Abstract
ObjectiveTo investigate the value of a two-step approach with cytokeratin-18 (CK-18) and controlled attenuation parameter (CAP) in the noninvasive diagnosis of nonalcoholic steatohepatitis (NASH).
MethodsA total of 65 patients with biopsy-proven nonalcoholic fatty liver disease were enrolled, including 30 patients with NASH. The M30 and M65 enzyme-linked immunosorbent assay kits were used to measure serum CK-18, and FibroScan was used to measure CAP. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUROC) was used to determine the value of noninvasive diagnosis. The binary logistic regression model was used to calculate the predicted probability of combined diagnosis. The maximum Youden index, a sensitivity of >90%, and a specificity of > 90% were used to determine the optimal cut-off value, the low value, and the high value, respectively.
ResultsThe results of the multivariate analysis showed that M65 (OR = 1.004, 95% CI 1.002-1.007, P = 0.003) and CAP (OR = 1.017, 95% CI 1.001-1.033, P = 0.036) were independent predictors of NASH. The AUROC of M65+CAP was 0.851 (95% CI 0.761-0.942), higher than 0.808 (95% CI 0.702-0.913) of M65 and 0.677 (95% CI 0.545-0.808) of CAP alone. A two-step approach with high (820.8 U/L) and low (527.7 U/L) values for M65 and the optimal cut-off value (293.5 dB/m) for CAP was used for the differential diagnosis of NASH, with a positive predictive value of 85.7%, a negative predictive value of 100%, and a coincidence rate of 92.0%.
ConclusionA two-step approach with M65 and CAP can improve the value of noninvasive diagnosis of NASH, and a high negative predictive value can avoid unnecessary liver biopsy.
Key words:
Nonalcoholic steatohepatitis; Controlled attenuation parameter; Cytokeratin-18; Non-invasive assessment
Contributor Information
Feng Shen
Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Ruidan Zheng
Research and Therapy Centre for Liver Disease, Zhengxing Hospital, Zhangzhou Fujian 363000, China
Yuqiang Mi
Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin 300150, China
Junping Shi
Department of Liver Diseases, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 311121, China
Xiaoying Wang
Department of Pathology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Xiqi Hu
Department of Pathology, Shanghai Medical College of Fudan University, Shanghai 200032, China
Qin Pan
Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Leiming Xu
Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Jiangao Fan
Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
