Noninvasive Prediction Model to Determine Resolution of Nonalcoholic Steatohepatitis

Summary and Comment |
June 6, 2016

Noninvasive Prediction Model to Determine Resolution of Nonalcoholic Steatohepatitis

  1. Atif Zaman, MD, MPH

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

  1. Atif Zaman, MD, MPH

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.

Comment

This predictive model using readily available data would allow clinicians to assess treatment success in their NASH patients. Once results of this study are further validated in other cohorts, hopefully a simple app could be developed for use in clinical practice.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

Citation(s):

Reader Comments (3)

ROBERT BARKER Physician, Gastroenterology, Retired

When is it appropriate to tell a patient that a sensible diet, regular exercise, maintenance of a sensible weight, and reasonable diabetic control are no longer necessary? Stopping medications, if any, would seem reasonable.

Atif Zaman, MD, MPH

What does this change with respect to ongoing management decisions?
Once effective NASH treatment beyond weight loss is approved the hope is that such non-invasive scoring systems will help guide clinicians in determining effectiveness of interventions that are employed.

Are there proven treatment options for the patients who fail to improve on dietary changes?
There are new medical therapies on the horizon such as Obeticholic acid

If the biopsy, or this scale indicate improvement, can the patient safely go off said interventional diet?
Unknown

Atif Zaman, MD, MPH

CHRISTOPHER THOMAS

What does this change with respect to ongoing management decisions? Are there proven treatment options for the patients who fail to improve on dietary changes? If the biopsy, or this scale indicate improvement, can the patient safely go off said interventional diet?

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