Original article—liver, pancreas, and biliary tractComparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease
Section snippets
Study Population
The study population consisted of subjects with histologically proven NAFLD who were enrolled in the National Institutes of Health (NIH) NASH Clinical Research Network (CRN). The NASH CRN has three sets of subjects: (1) those enrolled in a natural history database; (2) those enrolled in a randomized clinical trial of pioglitazone or vitamin E versus placebo (PIVENS) in adults; and (3) a randomized clinical trial of metformin or vitamin E versus placebo (TONIC) in pediatric subjects with NAFLD.
Results
A total of 541 subjects were included for this analysis. Of these, 325 (60%) were women and 400 (74%) were Caucasian (Table 2); 105 (19%) had type 2 diabetes mellitus and 239 (44%) were hypertensive. A total of 317 subjects had steatohepatitis; of these, 101 subjects had advanced fibrosis. A total of 224 subjects who had fatty liver disease but did not meet the NASH CRN definition of steatohepatitis were also included. Of these 224 subjects, 24 had advanced fibrosis. As expected, subjects with
Discussion
An ideal noninvasive test for assessment of hepatic fibrosis would be one that is sensitive, specific, free of additional cost to the patient, and applicable across all chronic liver diseases. In the context of NAFLD, such a test should also be able to distinguish between a fatty liver and steatohepatitis. Unfortunately, none of the currently available tests meets these criteria and the search for such a marker goes on.
In the absence of an ideal marker, the utility of any marker should take
Acknowledgments
Members of the Nonalcoholic Steatohepatitis Clinical Research Network: Clinical Centers: Baylor College of Medicine, Houston, TX: Stephanie Abrams, MD, Diana Arceo, Denise Espinosa, and Leanel Fairly. Case Western Reserve University Clinical Centers: MetroHealth Medical Center, Cleveland, OH: Arthur McCullough, MD, PI, Diane Bringman, RN, BSN, Srinivasan Dasarathy, MD, Carol Hawkins, RN, Yao-Chang Liu, MD, Nicholette Rogers, PhD, PA-C, and Margaret Stager, MD; and Cleveland Clinic Foundation,
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Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by grants from the National Institutes of Health to the NASH Clinical Research Network (U01DK61718, U01DK61728, U01DK61731, U01DK61732, U01DK61734, U01DK61737, U01DK61738, U01DK61730, U01DK61713).