Clinical Correlates of Histopathology in Pediatric Nonalcoholic Steatohepatitis

Heather M. Patton, Joel E. Lavine, Mark L. Van Natta, Jeffrey B. Schwimmer, David Kleiner, Girish Subbarao

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

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 the requirement for liver biopsy or predict those at increased risk for progression. Methods: Data obtained prospectively from children (age, 6-17 y) enrolled in the NASH Clinical Research Network were analyzed to identify clinical-pathologic correlates of pediatric NAFLD. All participants underwent liver biopsy within 6 months of clinical data that were reviewed by a central pathology committee. Results: A total of 176 children (mean age, 12.4 y; 77% male) were eligible for inclusion. By using ordinal logistic regression analysis, increasing aspartate aminotransferase (AST) level (odds ratio [OR], 1.017 per U/L; 95% confidence interval [CI], 1.004-1.031) and γ-glutamyltransferase level (OR, 1.016 per U/L; 95% CI, 1.000-1.033) were associated independently with increasing severity of NASH. Increasing AST level (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 associated independently with increasing severity of fibrosis. Area under the receiver operator characteristic curve for a model with AST and alanine aminotransferase 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.

Original languageEnglish
JournalGastroenterology
Volume135
Issue number6
DOIs
StatePublished - Dec 2008

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Pediatrics
Confidence Intervals
Odds Ratio
Aspartate Aminotransferases
Fibrosis
Biopsy
Liver
Non-alcoholic Fatty Liver Disease
Alanine Transaminase
Leukocyte Count
Hematocrit
Liver Cirrhosis
Liver Diseases
Logistic Models
Regression Analysis
Pathology
Research

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical Correlates of Histopathology in Pediatric Nonalcoholic Steatohepatitis. / Patton, Heather M.; Lavine, Joel E.; Van Natta, Mark L.; Schwimmer, Jeffrey B.; Kleiner, David; Subbarao, Girish.

In: Gastroenterology, Vol. 135, No. 6, 12.2008.

Research output: Contribution to journalArticle

Patton, Heather M. ; Lavine, Joel E. ; Van Natta, Mark L. ; Schwimmer, Jeffrey B. ; Kleiner, David ; Subbarao, Girish. / Clinical Correlates of Histopathology in Pediatric Nonalcoholic Steatohepatitis. In: Gastroenterology. 2008 ; Vol. 135, No. 6.
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abstract = "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 the requirement for liver biopsy or predict those at increased risk for progression. Methods: Data obtained prospectively from children (age, 6-17 y) enrolled in the NASH Clinical Research Network were analyzed to identify clinical-pathologic correlates of pediatric NAFLD. All participants underwent liver biopsy within 6 months of clinical data that were reviewed by a central pathology committee. Results: A total of 176 children (mean age, 12.4 y; 77{\%} male) were eligible for inclusion. By using ordinal logistic regression analysis, increasing aspartate aminotransferase (AST) level (odds ratio [OR], 1.017 per U/L; 95{\%} confidence interval [CI], 1.004-1.031) and γ-glutamyltransferase level (OR, 1.016 per U/L; 95{\%} CI, 1.000-1.033) were associated independently with increasing severity of NASH. Increasing AST level (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 associated independently with increasing severity of fibrosis. Area under the receiver operator characteristic curve for a model with AST and alanine aminotransferase 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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