TY - JOUR
T1 - Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis (NASH)
AU - Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)
AU - Patton, Heather
AU - Lavine, Joel E.
AU - Van Natta, Mark L.
AU - Schwimmer, Jeffrey B.
AU - Kleiner, David
AU - Molleston, Jean
AU - McCullough, Arthur
AU - Stager, Margaret
AU - Feldstein, Ariel
AU - Diehl, Anna Mae
AU - Scheimann, Ann
AU - Chalasani, Naga
AU - Subbarao, Girish
AU - Tetri, Brent
AU - Barlow, Sarah
AU - Abrams, Stephanie
AU - Bass, Nathan
AU - Rosenthal, Philip
AU - Kowdley, Kris
AU - Murray, Karen
AU - Sanyal, Arun
AU - Bryan, Daphne
AU - Tonascia, James
AU - Robuck, Patricia
AU - Hoofnagle, Jay
AU - Huang, Terry
N1 - Funding Information:
The National Institute of Diabetes and Digestive and Kidney Diseases with additional support from the National Institute of Childhood Health and Human Development funded a Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) beginning in 2002. The objective of this network, composed of 8 clinical centers and a data coordinating center, is the conduct of research designed to progress understanding of the pathogenesis, natural history, prognostic features, and treatment of adult and pediatric NAFLD. 11,12 Data collected as part of the NASH CRN provide a unique resource in that the liver histology undergoes systematic review by an expert panel of pathologists. The aim of this study was to evaluate whether simple, readily available clinical and laboratory measures have predictive power with respect to the histologic pattern or severity of NAFLD among children enrolled in studies conducted at multiple centers within the NASH CRN.
PY - 2008/12/1
Y1 - 2008/12/1
N2 - Background & Aims - Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in American children. Noninvasive means to discriminate between NAFLD and nonalcoholic steatohepatitis (NASH) might diminish requirement for liver biopsy or predict those at increased risk for progression. Methods - Data obtained prospectively from children (aged 6-17 yrs) enrolled in the NASH Clinical Research Network (NASH CRN) were analyzed to identify clinical-pathological correlates of pediatric NAFLD. All participants underwent liver biopsy within 6 months of clinical data that was reviewed by a central pathology committee. Results - 176 children (mean age 12.4 years, 77% male) were eligible for inclusion. Using ordinal logistic regression analysis, increasing AST (OR 1.017 per U/L, 95% CI 1.004-1.031) and GGT (OR 1.016 per U/L, 95% CI 1.000-1.033) were independently associated with increasing severity of NASH. Increasing AST (OR 1.015 per U/L, 95% CI 1.006-1.024), increasing white blood cell count (OR 1.22 per 1000/mm3, 95% CI 1.07-1.38), and decreasing hematocrit (OR 0.87 per %, 95% CI 0.79-0.96) were independently associated with increasing severity of fibrosis. Area under the ROC for a model with AST and ALT was 0.75 (95% CI=0.66-0.84) and 0.74 (95% CI 0.63-0.85) for distinguishing steatosis from more advanced forms of NASH and bridging fibrosis from lesser degrees of fibrosis, respectively. Conclusions - Certain components of routine laboratory tests are predictive of NAFLD pattern and fibrosis severity, but do not have adequate discriminate power to replace liver biopsy in evaluating pediatric NAFLD.
AB - Background & Aims - Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in American children. Noninvasive means to discriminate between NAFLD and nonalcoholic steatohepatitis (NASH) might diminish requirement for liver biopsy or predict those at increased risk for progression. Methods - Data obtained prospectively from children (aged 6-17 yrs) enrolled in the NASH Clinical Research Network (NASH CRN) were analyzed to identify clinical-pathological correlates of pediatric NAFLD. All participants underwent liver biopsy within 6 months of clinical data that was reviewed by a central pathology committee. Results - 176 children (mean age 12.4 years, 77% male) were eligible for inclusion. Using ordinal logistic regression analysis, increasing AST (OR 1.017 per U/L, 95% CI 1.004-1.031) and GGT (OR 1.016 per U/L, 95% CI 1.000-1.033) were independently associated with increasing severity of NASH. Increasing AST (OR 1.015 per U/L, 95% CI 1.006-1.024), increasing white blood cell count (OR 1.22 per 1000/mm3, 95% CI 1.07-1.38), and decreasing hematocrit (OR 0.87 per %, 95% CI 0.79-0.96) were independently associated with increasing severity of fibrosis. Area under the ROC for a model with AST and ALT was 0.75 (95% CI=0.66-0.84) and 0.74 (95% CI 0.63-0.85) for distinguishing steatosis from more advanced forms of NASH and bridging fibrosis from lesser degrees of fibrosis, respectively. Conclusions - Certain components of routine laboratory tests are predictive of NAFLD pattern and fibrosis severity, but do not have adequate discriminate power to replace liver biopsy in evaluating pediatric NAFLD.
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U2 - 10.1053/j.gastro.2008.08.050
DO - 10.1053/j.gastro.2008.08.050
M3 - Article
C2 - 19013463
AN - SCOPUS:57249103570
SN - 0016-5085
VL - 135
SP - 1961-1971.e2
JO - Gastroenterology
JF - Gastroenterology
IS - 6
ER -