A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease

Sumida, Yoshio; Yoneda, Masato; Hyogo, Hideyuki; Yamaguchi, Kanji; Ono, Masafumi; Fujii, Hideki; Eguchi, Yuichiro; Suzuki, Yôichi; Imai, Shoichi; Kanemasa, Kazuyuki; Fujita, Koji; Chayama, Kazuaki; Yasui, Kohichiroh; Saibara, Toshiji; Kawada, Norifumi; Fujimoto, Kazuma; Kohgo, Yutaka; Okanoue, Takeshi

doi:10.1007/s00535-010-0305-6

Cited by 193 publications

(180 citation statements)

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“…Noninvasive assessment of NASH and advanced fibrosis in NAFLD There has been intense interest in the development of biochemical markers and scoring systems for predicting NASH or fibrosis [50][51][52][53]. Circulating levels of cytokeratin-18 (CK18) fragments have been investigated most extensively as a novel biomarker for the diagnosis of NASH [50].…”

Section: Diagnosismentioning

confidence: 99%

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

et al. 2015

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Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various noninvasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary.Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 to January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.

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Section: Diagnosismentioning

confidence: 99%

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

et al. 2015

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“…The score in the original NAFIC scoring system is calculated as the weighted sum of three clinical variables [Serum ferritin ≥ 200 ng/ml (female) or ≥ 300 ng/ml (male), 1 point; serum fasting insulin ≥ 10 μU/ml, 1 point; serum type IV collagen 7S ≥ 5.0 ng/ml, 2 points] (Table 1a). It has been demonstrated that the possibility of NASH is high when the NAFIC score is 2 or higher [6]. The modified NAFIC score is also a weighted sum of the scores for the three clinical variables, although the weightage given to higher fasting serum insulin levels is higher than that in the original NAFIC scoring system [Serum ferritin ≥ 200 ng/ml (female) or ≥ 300 ng/ml (male), 1 point; serum type IV collagen 7S ≥ 5.0 ng/ml, 2 points; serum fasting insulin 10-15 μU/ml, 1 point and ≥ 15 μU/ml, 2 points] (Table 1b).…”

Section: Clinical and Laboratory Evaluationmentioning

confidence: 99%

“…Ferritin (ng/ml) <200 (female) or <300 (male) 0 ≥200 (female) or ≥300 (male) 1 Type IV collagen 7S (ng/ml) <5 0 ≥5 2 Table 1a: The criteria in the original NAFIC scoring system [6,10].…”

Section: ≥10mentioning

confidence: 99%

“…Type IV collagen 7S (ng/ml) <5 0 ≥5 2 Table 1b: The criteria in the modified NAFIC scoring system [6,10]. …”

Section: Clinical Parameter Definition Pointmentioning

confidence: 99%

“…While numerous non-invasive tests for differentiating NASH from NAFL have been developed [5], the NAFIC scoring system, based on the serum level of ferritin, fasting serum level of insulin and serum level of type IV collagen 7S, has been recognized as a simple and reasonably accurate and clinically useful tool for predicting the presence of NASH in Japanese patients with NAFLD [6]. Furthermore, a modified NAFIC scoring system has also been developed, modified by changing the weightage assigned to the fasting serum insulin level based on the importance of hyperinsulinemia in the pathogenesis of NASH [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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A Caution in the use of the NAFIC Scoring System as a Diagnostic Screening Tool for Nonalcoholic Steatohepatitis

Nakamura¹,

Yoneda²,

Sumida³

et al. 2014

J Gastroint Dig Syst

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Objective: We reinvestigated the clinical usefulness of the NAFIC and modified NAFIC scoring systems in Japanese patients with nonalcoholic fatty liver disease (NAFLD) according to the presence/absence of obesity.Methods: A total of 141 Japanese patients with liver-biopsy-confirmed NAFLD were enrolled. All patients were classified as having nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH) on the basis of Matteoni's classification. Obesity was defined as a body mass index of ≥25. To evaluate the overall accuracy of the NAFIC and modified NAFIC scoring systems, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of these scoring systems for the diagnosis of NASH were calculated. Results:In the obese group, the sensitivity, specificity, PPV and NPV of the NAFIC scoring system for the diagnosis of NASH were 67.3%, 76.2%, 77.8% and 65.3%, respectively, while the corresponding values for the modified NAFIC scoring systems were 78.8%, 69.0%, 75.9% and 72.5%. On the other hand, in the nonobese group, the sensitivity, specificity, PPV and NPV of the NAFIC scoring system were 47.1%, 86.7%, 66.7% and 74.3%, respectively, while those of the modified NAFIC scoring system were 58.8%, 83.3%, 66.7% and 78.1%, respectively. When the patients were divided by sex, the sensitivity of the NAFIC and modified NAFIC scoring systems in the female nonobese group were 53.8% and 69.2%, respectively. However, surprisingly, in the male nonobese group, the sensitivity of both the scoring systems was only 25.0%. Conclusion:The sensitivity of both the NAFIC and modified NAFIC scoring systems for the diagnosis of NASH was lower in the male nonobese group than in all the other groups. These findings suggest that caution should be exercised in the use of the NAFIC scoring system as a diagnostic screening tool for NASH in Japanese patients with NAFLD, especially male nonobese patients.

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The clinical utility of noninvasive blood tests and elastography

Tsochatzis

Pinzani

2016

Clinical Dilemmas in Non‐Alcoholic Fatty Liver Disease

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A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease

Abstract: NAFIC score can predict NASH in Japanese NAFLD patients with sufficient accuracy and simplicity to be considered for clinical use.

Cited by 193 publications

References 44 publications

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

A Caution in the use of the NAFIC Scoring System as a Diagnostic Screening Tool for Nonalcoholic Steatohepatitis

The clinical utility of noninvasive blood tests and elastography

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