Evidence-Based Medicine
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World J Gastroenterol. Aug 7, 2014; 20(29): 10108-10114
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10108
Simple scoring system for predicting cirrhosis in nonalcoholic fatty liver disease
Takaomi Kessoku, Yuji Ogawa, Masato Yoneda, Kento Imajo, Yoshio Sumida, Yuichiro Eguchi, Hideki Fujii, Hideyuki Hyogo, Masafumi Ono, Yasuaki Suzuki, Takumi Kawaguchi, Kazuaki Chayama, Saiyu Tanaka, Kazuma Fujimoto, Keizo Anzai, Toshiji Saibara, Michio Sata, Yoshito Itoh, Atsushi Nakajima, Takeshi Okanoue; Japan Study Group of NAFLD (JSG-NAFLD)
Takaomi Kessoku, Yuji Ogawa, Masato Yoneda, Kento Imajo, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Yoshio Sumida, Yoshito Itoh, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan
Yuichiro Eguchi, Department of General Medicine, Saga Medical School, Saga 849-8501, Japan
Hideki Fujii, Department of Hepatology, Osaka City University, Osaka 558-8585, Japan
Hideyuki Hyogo, Kazuaki Chayama, Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 730-0053, Japan
Masafumi Ono, Toshiji Saibara, Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi 783-8505, Japan
Yasuaki Suzuki, Department of Gastroenterology, Nayoro City General Hospital, , Hokkaido 096-8511, Japan
Takumi Kawaguchi, Michio Sata, Department of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan
Saiyu Tanaka, Department of Internal Medicine, Nara City Hospital, Nara 634-8522, Japan
Kazuma Fujimoto, Keizo Anzai, Department of Internal Medicine, University Hospital, Saga 849-8577, Japan
Takeshi Okanoue, Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka 565-0862, Japan
Author contributions: Kessoku T contributed to the design, statistical analysis, manuscript development and final revision of the paper; Ogawa Y, Yoneda M, Imajo K, Sumida Y, Eguchi Y, Hyogo H, Ono M, Kawaguchi T, Saibara T, Sata M, Itoh Y, Nakajima A and Okanoue T contributed to the design, the concept, acquisition, the interpretation data, drafting and revising of the manuscript; Fujii H, Suzuki Y, Chayama K, Tanaka S, Fujimoto K and Anzai K contributed to their practical and intellectual input; All authors read and approved the final manuscript.
Correspondence to: Masato Yoneda, MD, PhD, Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan. dryoneda@yahoo.co.jp
Telephone: +81-45-7872640  Fax: +81-45-7843546
Received: November 16, 2013
Revised: January 9, 2014
Accepted: April 21, 2014
Published online: August 7, 2014
Abstract

AIM: To investigate a simple noninvasive scoring system for predicting liver cirrhosis in nonalcoholic fatty liver disease (NAFLD) patients.

METHODS: A total of 1048 patients with liver-biopsy-confirmed NAFLD were enrolled from nine hepatology centers in Japan (stage 0, 216; stage 1, 334; stage 2, 270; stage 3, 190; stage 4, 38). The weight and height of the patients were measured using a calibrated scale after requesting the patients to remove their shoes and any heavy clothing. Venous blood samples were obtained in the morning after the patients had fasted overnight for 12 h. Laboratory evaluation was performed in all patients. Statistical analysis was conducted using SPSS version 12.0. Continuous variables were expressed as mean ± SD.

RESULTS: The optimal cutoff value of platelet count, serum albumin, and aminotransferase/alanine aminotransferase ratio (AAR) was set at < 15.3 104/μL, < 4.0 g/dL, and > 0.9, respectively, by the receiver operating characteristic curve. These three variables were combined in an unweighted sum (platelet count = 1 point, serum albumin = 1 point, AAR = 1 point) to form an easily calculated composite score for predicting cirrhosis in NAFLD patients, called the PLALA (platelet, albumin, AAR) score. The diagnosis of PLALA ≥ 2 had sufficient accuracy for detecting liver cirrhosis in NAFLD patients.

CONCLUSION: The PLALA score may be an ideal scoring system for detecting cirrhosis in NAFLD patients with sufficient accuracy and simplicity to be considered for clinical use.

Keywords: Nonalcoholic fatty liver disease, Cirrhosis, Fibrosis, Platelet, Albumin, Alanine aminotransferase ratio

Core tip: Nonalcoholic fatty liver disease (NAFLD) is an important cause of chronic and progressive liver injury. We aimed to develop a simple noninvasive scoring system for predicting liver cirrhosis in NAFLD patients. These three variables were combined in an unweighted sum [platelet count = 1 point, serum albumin = 1 point, aminotransferase (AST)/alanine aminotransferase (ALT) ratio = 1 point] to form an easily calculated composite score, called the PLALA (platelet, albumin, AST/ALT ratio) score. The diagnosis of PLALA ≥ 2 had sufficient accuracy for detecting liver cirrhosis in NAFLD patients. The PLALA score may be an ideal scoring system for detecting cirrhosis in NAFLD patients.