New scoring system combining the FIB-4 index and cytokeratin-18 fragments for predicting steatohepatitis and liver fibrosis in patients with nonalcoholic fatty liver disease

Purpose: To establish a new scoring system as a noninvasive tool for predicting steatohepatitis and liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD).Methods: A total of 170 patients histologically diagnosed with nonalcoholic steatohepatitis (NASH) (n=130) or nonalcoholic fatty liver (NAFL) (n=40) were enrolled. We analyzed receiver operating characteristic (ROC) curves and performed multivariate analysis to predict steatohepatitis and liver fibrosis.Results: Multivariate analysis showed that cytokeratin-18 fragment (CK18-F) levels (278U/L) (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.42-14.00; p=0.010) and the FIB-4 index (1.46) (OR, 4.54; 95% CI, 1.93-29.50; p=0.004) were independently associated with prediction of NASH. We then established a new scoring system (named the FIC-22 score) for predicting NASH using CK18-F levels and FIB-4 index. The areas under the ROC curve (AUROCs) of the FIC-22 score and NAFIC score were 0.82 (95% CI, 0.75-0.89) and 0.71 (95% CI, 0.62-0.78) (p=0.044). Additionally, the AUROC of the FIC-22 score for predicting the presence of fibrosis (F1) was 0.78 (95% CI, 0.70-0.85).Conclusions: In patients with NAFLD, the FIC-22 score had high predictive accuracy not only for steatohepatitis but also for the presence of liver fibrosis.