Utility of a New Model to Diagnose an Alcohol Basis for Steatohepatitis

Winston Dunn, Paul Angulo, Schuyler Sanderson, Laith H. Jamil, Linda Stadheim, Charles Rosen, Michael Malinchoc, Patrick Sequeira Kamath, Vijay Shah

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Distinguishing an alcohol basis from a nonalcoholic basis for the clinical and histologic spectrum of steatohepatitic liver disease is difficult because of unreliability of alcohol consumption history. Unfortunately, various biomarkers have had limited utility in distinguishing alcoholic liver disease (ALD) from nonalcoholic fatty liver disease (NAFLD). Thus, the aim of our study was to create and validate a model to diagnose ALD in patients with steatohepatitis. Methods: A cross-sectional cohort study was performed at the Mayo Clinic, Rochester, Minnesota, to create a model using multivariable logistic regression analysis. This model was validated in 3 independent data sets comprising patients of varying severity of steatohepatitis spanning over 10 years. Results: Logistic regression identified mean corpuscular volume, aspartate aminotransferase (AST)/alanine aminotransfersase (ALT) ratio, body mass index, and gender as the most important variables that separated patients with ALD from NAFLD. These variables were used to generate the ALD/NAFLD Index (ANI), with ANI of greater than zero incrementally favoring ALD and ANI of less than zero incrementally favoring a diagnosis of NAFLD, thus making ALD unlikely. ANI had a c-statistic of 0.989 in the derivation sample, and 0.974, 0.989, 0.767 in the 3 validation samples. ANI performance characteristics were significantly better than several conventional and recently proposed biomarkers used to differentiate ALD from NAFLD, including the histopathologic marker protein tyrosine phosphatase 1b, AST/ALT ratio, γ-glutamyl transferase, and carbohydrate-deficient transferrin. Conclusions: ANI, derived from easily available objective variables, accurately differentiates ALD from NAFLD in hospitalized, ambulatory, and pretransplantation patients and compares favorably with other traditional and proposed biomarkers.

Original languageEnglish (US)
Pages (from-to)1057-1063
Number of pages7
JournalGastroenterology
Volume131
Issue number4
DOIs
StatePublished - Oct 2006

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Fatty Liver
Alcoholic Liver Diseases
Alcohols
Biomarkers
Aspartate Aminotransferases
Alanine
Non-alcoholic Fatty Liver Disease
Logistic Models
Non-Receptor Type 1 Protein Tyrosine Phosphatase
Erythrocyte Indices
Transferases
Alcohol Drinking
Liver Diseases
Body Mass Index
Cohort Studies
Cross-Sectional Studies
History
Regression Analysis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Dunn, W., Angulo, P., Sanderson, S., Jamil, L. H., Stadheim, L., Rosen, C., ... Shah, V. (2006). Utility of a New Model to Diagnose an Alcohol Basis for Steatohepatitis. Gastroenterology, 131(4), 1057-1063. https://doi.org/10.1053/j.gastro.2006.08.020

Utility of a New Model to Diagnose an Alcohol Basis for Steatohepatitis. / Dunn, Winston; Angulo, Paul; Sanderson, Schuyler; Jamil, Laith H.; Stadheim, Linda; Rosen, Charles; Malinchoc, Michael; Kamath, Patrick Sequeira; Shah, Vijay.

In: Gastroenterology, Vol. 131, No. 4, 10.2006, p. 1057-1063.

Research output: Contribution to journalArticle

Dunn, W, Angulo, P, Sanderson, S, Jamil, LH, Stadheim, L, Rosen, C, Malinchoc, M, Kamath, PS & Shah, V 2006, 'Utility of a New Model to Diagnose an Alcohol Basis for Steatohepatitis', Gastroenterology, vol. 131, no. 4, pp. 1057-1063. https://doi.org/10.1053/j.gastro.2006.08.020
Dunn W, Angulo P, Sanderson S, Jamil LH, Stadheim L, Rosen C et al. Utility of a New Model to Diagnose an Alcohol Basis for Steatohepatitis. Gastroenterology. 2006 Oct;131(4):1057-1063. https://doi.org/10.1053/j.gastro.2006.08.020
Dunn, Winston ; Angulo, Paul ; Sanderson, Schuyler ; Jamil, Laith H. ; Stadheim, Linda ; Rosen, Charles ; Malinchoc, Michael ; Kamath, Patrick Sequeira ; Shah, Vijay. / Utility of a New Model to Diagnose an Alcohol Basis for Steatohepatitis. In: Gastroenterology. 2006 ; Vol. 131, No. 4. pp. 1057-1063.
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