The independent predictors of NASH and its individual histological features. Insulin resistance, serum uric acid, metabolic syndrome, ALT and serum total cholesterol are a clue to pathogenesis and candidate targets for treatment

Hepatology Research : the Official Journal of the Japan Society of Hepatology
Stefano BallestriAmedeo Lonardo

Abstract

The diagnosis of nonalcoholic steatohepatitis (NASH) is based on the individual histological features: steatosis, lobular inflammation and ballooning. NAFLD activity score (NAS ≥ 5) is used in clinical trials. Fibrosis dictates long-term NAFLD prognosis. Recently, more-than-mild portal inflammation has raised interest as a marker of NAFLD severity. We assessed the independent predictors of a) individual histological lesions of NASH, b) diagnosis of NASH, c) significant (stage ≥ 2) and advanced (stage ≥3) fibrosis and d) more-than-mild portal inflammation. Data from 118 consecutive biopsy-proven NAFLD patients observed at our Institution were retrospectively analyzed. At stepwise multivariate logistic regression analyses, independent predictors were: a) for the individual histological features of NASH: insulin resistance, assessed with Homeostasis Model Assessment (HOMA-IR), serum uric acid (SUA) and serum total cholesterol (TCH) for moderate-to-severe steatosis; waist circumference (waist), HOMA and TCH for lobular inflammation; waist, HOMA-IR, metabolic syndrome (MS), serum alanine aminotransferase (ALT), SUA and TCH for ballooning. b) for NASH diagnosis: waist, HOMA-IR, MS, ALT, SUA and TCH (Brunt's classification); ALT, SUA ...Continue Reading

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