Pulzi et al reported a clinical score the diagnosis of nonalcoholic steatohepatitis (NASH) in an obese adult. Use of the score may avoid the need for a liver biopsy. The authors are from Imandade da Santa Casa de Misericordia de Sao Paula in Brazil.
Patient selection: obese adult (BMI > 40 in most subjects)
Parameters:
(1) serum total cholesterol in mg/dL
(2) serum ALT in IU/L
(3) AST to ALT ratio (AAR)
(4) serum GGT in IU/L
(5) hepatic steatosis on abdominal ultrasound
Parameter
Finding
Points
serum total cholesterol
< 200 mg/dL
0
>= 200 mg/dL
1
serum ALT
< 30 IU/L
0
>= 30 IU/L
1
AST to ALT ratio
> 1
0
<= 1
1
serum GGT
< 30 IU/L
0
>= 30 IU/L
1
steatosis on abdominal ultrasound
absent
0
present
1
where:
• The reference ranges for serum tests not given.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 4 had a sensitivity of 70% and specificity of 89%.
Alternatively, a simplified score can be calculated using the first 4 parameters. This score has a maximum value of 4, with a score >= 3 70% sensitive and 75% specific.
Performance:
• The area under the ROC curve was 0.82.
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