There is an urgent need to identify patients with ‘at-risk’ nonalcoholic steatohepatitis (NASH), i.e. defined as NAFLD activity score ≥4 and fibrosis stage ≥2 on liver histology, as these patients are required to test the efficacy of new pharmaceutical drugs for NASH in clinical trials. Traditional non-invasive tests (NITs) have been developed to identify either NASH (plasma cytokeratin-18 [CK-18] fragments M30/M65) or advanced fibrosis, such as fibrosis-4 index, NAFLD fibrosis score or Enhanced Liver Fibrosis test. However, these NITs do not perform well in detecting ‘at-risk’ NASH. Recently, Harrison et al.1 developed and validated a novel blood-based diagnostic test (namely the NIS4 algorithm) that provides an effective way to rule in or rule out ‘at-risk’ NASH (with an area under the receiver operating characteristics curve of 0.80, 95% confidence interval 0.73-0.85). To our knowledge, there are only two other NITs that can be used to detect ‘at-risk’ NASH, i.e. the Fibroscan-AST (FAST) and MACK-3 scores. Specifically, the NIS4 (that includes miR-34a-5p, alpha-2 macroglobulin, YKL-40, and glycated haemoglobin in its equation), and the MACK-3 score (that includes homeostasis model assessment-estimated insulin resistance, serum AST and CK-18 levels) are two blood-based diagnostic tests, while the FAST score (that includes liver stiffness measurement, controlled attenuation parameter, and serum AST levels) is principally derived from Fibroscan®.

Noninvasive diagnosis of non-alcoholic steatohepatitis and liver fibrosis

Targher, Giovanni
Writing – Review & Editing
;
2021-01-01

Abstract

There is an urgent need to identify patients with ‘at-risk’ nonalcoholic steatohepatitis (NASH), i.e. defined as NAFLD activity score ≥4 and fibrosis stage ≥2 on liver histology, as these patients are required to test the efficacy of new pharmaceutical drugs for NASH in clinical trials. Traditional non-invasive tests (NITs) have been developed to identify either NASH (plasma cytokeratin-18 [CK-18] fragments M30/M65) or advanced fibrosis, such as fibrosis-4 index, NAFLD fibrosis score or Enhanced Liver Fibrosis test. However, these NITs do not perform well in detecting ‘at-risk’ NASH. Recently, Harrison et al.1 developed and validated a novel blood-based diagnostic test (namely the NIS4 algorithm) that provides an effective way to rule in or rule out ‘at-risk’ NASH (with an area under the receiver operating characteristics curve of 0.80, 95% confidence interval 0.73-0.85). To our knowledge, there are only two other NITs that can be used to detect ‘at-risk’ NASH, i.e. the Fibroscan-AST (FAST) and MACK-3 scores. Specifically, the NIS4 (that includes miR-34a-5p, alpha-2 macroglobulin, YKL-40, and glycated haemoglobin in its equation), and the MACK-3 score (that includes homeostasis model assessment-estimated insulin resistance, serum AST and CK-18 levels) are two blood-based diagnostic tests, while the FAST score (that includes liver stiffness measurement, controlled attenuation parameter, and serum AST levels) is principally derived from Fibroscan®.
2021
Non-invasive tests; NAFLD; nonalcoholic steatohepatitis; NASH; liver fibrosis
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1034217
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