Model of Palekar et al for Distinguishing Nonalcoholic Steatohepatitis (NASH) from Simple Steatosis

 

Parameters:

(1) age of the patient in years

(2) gender

(3) serum AST in IU/L

(4) body mass index (BMI)

(5) serum AST to ALT ratio (AAR)

(6) serum hyaluronic acid (HA) in µg/L

 

Parameter	Finding	Points
age of the patient in years	< 50 years	0
	>= 50 years	1
gender	male	0
	female	1
serum AST	< 45 IU/L	0
	>= 45 IU/L	1
AST to ALT ratio	< 0.80	0
	>= 0.80	1
body mass index	< 30 kg per square meter	0
	>= 30 kg per square meter	1
serum hyaluronic acid	< 55 µg/L	0
	>= 55 µg/L	1

 

number of parameters present =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum number of parameters: 0

• maximum number of parameters: 6

• A cutoff of 3 or more parameters was used to identify a patient with NASH.

• A hyaluronic acid concentration of >= 45.3 µg/L predicted advanced fibrosis (Stage 3 or 4) in a patient with NASH.

 

Performance:

• The sensitivity at the cutoff was 74% and specificity 66% (mediocre).

• The positive predictive value was 68% and negative predictive value 71%.

 

Limitations:

• Laboratory measurement of AST, ALT and HA must be comparable.

• Hyaluronic acid was measured on Wako LiBASys Immunoassay Analyzer. The normal reference range was not reported.