Independent Predictors of Steatohepatitis and Fibrosis in Asian Indian Patients with Non-Alcoholic Steatohepatitis

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Abstract
Aim To identify the clinical and biochemical predictors of histologic disease severity in patients with non-alcoholic steatohepatitis (NASH). Method Clinical, anthropometric and biochemical data of 71 consecutive patients with a histological diagnosis of NASH were retrieved from the medical database. The histologic criteria proposed at the American Association for the Study of Liver Diseases Conference (2003) were followed. Histologic features and the necro-inflammatory grade of liver biopsy were scored in accordance with the Brunt score. Statistical analysis was performed to identify predictors of disease severity. Results The male to female ratio of the study cohort was 3.1:1. The mean body mass index (BMI) of the patients was 25.67 ± 1.9 kg/m2. In terms of necroinflammatory grading, 21 (29.6%) patients were classified as grade 1, 26 (36.6%) as grade 2 and 24 (33.8%) as grade 3. Multivariate analysis revealed that BMI (P = 0.009), waist circumference (P = 0.035), waist:hip ratio (P = 0.011) and aspartate aminotransferase levels (P < 0.001) were independent predictors of necroinflammatory grade and that female gender (P = 0.02), serum alkaline phosphatase levels (P = 0.018), cholesterol levels (P = 0.048) and low-density lipoprotein (LDL) levels (P = 0.025) were independent predictors of fibrosis stage. Conclusion Female gender, BMI, waist:hip ratio, hypercholesterolemia and LDL levels are independent predictors of disease severity in patients with NASH and may influence the decision to biopsy.