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. 2006 Oct;131(4):1057-63.
doi: 10.1053/j.gastro.2006.08.020. Epub 2006 Aug 10.

Utility of a new model to diagnose an alcohol basis for steatohepatitis

Winston Dunn  1 , Paul Angulo, Schuyler Sanderson, Laith H Jamil, Linda Stadheim, Charles Rosen, Michael Malinchoc, Patrick S Kamath, Vijay H Shah
Affiliations

Utility of a new model to diagnose an alcohol basis for steatohepatitis

Winston Dunn et al. Gastroenterology. 2006 Oct.

Abstract

Background & aims: Distinguishing an alcohol basis from a nonalcoholic basis for the clinical and histologic spectrum of steatohepatitic liver disease is difficult because of unreliability of alcohol consumption history. Unfortunately, various biomarkers have had limited utility in distinguishing alcoholic liver disease (ALD) from nonalcoholic fatty liver disease (NAFLD). Thus, the aim of our study was to create and validate a model to diagnose ALD in patients with steatohepatitis.

Methods: A cross-sectional cohort study was performed at the Mayo Clinic, Rochester, Minnesota, to create a model using multivariable logistic regression analysis. This model was validated in 3 independent data sets comprising patients of varying severity of steatohepatitis spanning over 10 years.

Results: Logistic regression identified mean corpuscular volume, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, body mass index, and gender as the most important variables that separated patients with ALD from NAFLD. These variables were used to generate the ALD/NAFLD Index (ANI), with ANI of greater than zero incrementally favoring ALD and ANI of less than zero incrementally favoring a diagnosis of NAFLD, thus making ALD unlikely. ANI had a c-statistic of 0.989 in the derivation sample, and 0.974, 0.989, 0.767 in the 3 validation samples. ANI performance characteristics were significantly better than several conventional and recently proposed biomarkers used to differentiate ALD from NAFLD, including the histopathologic marker protein tyrosine phosphatase 1b, AST/ALT ratio, gamma-glutamyl transferase, and carbohydrate-deficient transferrin.

Conclusions: ANI, derived from easily available objective variables, accurately differentiates ALD from NAFLD in hospitalized, ambulatory, and pretransplantation patients and compares favorably with other traditional and proposed biomarkers.

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Figures

Figure 1
Figure 1. ANI compared to other proposed and traditional markers
ROC curves and c-statistics were generated to compare ANI (black) to AST/ALT ratio (dark gray), GGT (light gray) and CDT (dotted line) for distinguishing ALD from NAFLD. Data for ANI and AST/ALT ratio are generated from aggregate of the three validation samples. GGT is based on Validation Sample 1 while CDT is based on Validation Sample 2. ANI was significantly more accurate in distinguishing ALD from NAFLD compared to other markers (p<0.05).
Figure 2
Figure 2. Distribution of ANI in active drinkers and abstinent patients
The distribution of ANI in abstinent patients (dark gray line) and actively drinking patients (black line) were similar. ANI in NAFLD patients is shown as a relative comparator (light gray line). The median ANI in NAFLD patients, abstinent ALD patients, and ALD active drinkers were: -7.01 (light gray reference line), 3.44 (dark gray reference line) and 6.68 (black reference line), respectively.
Figure 3
Figure 3. Predicted probability of ALD based on ANI
The solid line curve demonstrates the predicted probability of ALD based on a given ANI. Predicted probability is calculated by eANI / (1+ eANI). Actual proportion of ALD is compiled from the three validation samples in aggregate. The dotted line represents the 95% confidence interval of the predicted probability.
See this image and copyright information in PMC

Comment in

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