Controlled attenuation parameter for non-invasive assessment of hepatic steatosis in Chinese patients

doi:10.3748/wjg.v20.i16.4702

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Apr 28, 2014; 20(16): 4702-4711
Published online Apr 28, 2014. doi: 10.3748/wjg.v20.i16.4702

Table 1 Baseline characteristics of patients with non-alcoholic fatty liver disease and chronic hepatitis B virus infection

Characteristics	All patients	NAFLD	CHB	P value
Characteristics	(n = 152)	(n = 52)	(n = 100)	P value
Demographics
Male gender, n (%)¹	106 (69.3)	36 (69.2)	70 (70.0)	0.992
Age (yr)²	35 (28-49)	39 (29-50)	35 (27-49)	0.167
Anthropometrics
BMI (kg/m²)²	24.9 (22.5-27.7)	26.0 (24.4-29.3)	23.9 (21.8-26.6)	< 0.001
< 18.5	7 (4.6)	0	7 (7.0)
18.5-24.9	70 (46.1)	18 (34.6)	52 (52.0)
25-29.9	61 (40.1)	24 (46.2)	37 (37.0)
≥ 30	14 (9.2)	10 (19.2)	4 (4.0)
WHR2	0.92 (0.88-0.96)	0.94 (0.91-0.97)	0.90 (0.86-0.95)	0.001
Laboratory findings
ALT (U/L)	64.8 (37.9-134.0)	55.0 (31.3-104.4)	69.0 (40.0-187.0)	0.022
AST (U/L)	44.0 (26.0-77.5)	33.4 (25.0-67.0)	46.3 (28.7-93.5)	0.042
ALP (U/L)	89.0 (68.0-109.0)	84.0 (63.1-109.0)	90.3 (73.3-109.0)	0.320
Γ-GT (U/L)	54.3 (28.9-104.4)	60.0 (31.6-97.1)	52.0 (26.5-117.3)	0.770
Albumin (g/L)	42.7 (39.8-45.1)	43.5 (41.5-46.8)	42.1 (38.6-44.8)	0.017
Total bilirubin (μmol/L)	14.2 (11.6-20.2)	12.6 (10.5-15.5)	15.2 (12.1-22.3)	0.003
Direct bilirubin (μmol/L)	4.9 (3.7-7.8)	4.6 (3.8-5.6)	5.2 (3.7-9.0)	0.080
Total cholesterol (mmol/L)	4.6 (4.0-5.1)	4.7 (4.3-5.1)	4.3 (3.7-5.1)	0.018
Triglyceride (mmol/L)	1.4 (0.9-2.2)	2.0 (1.3-2.7)	1.3 (0.87-2.0)	0.001
HDL-C (mmol/L)	1.2 (1.0-1.3)	1.2 (1.1-1.4)	1.1 (1.0-1.3)	0.166
LDL-C (mmol/L)	2.5 (1.9-2.9)	2.8 (2.6-3.1)	2.3 (1.8-2.6)	< 0.001
Prothrombin time (s)	12.3 (11.1-13.0)	11.9 (10.4-12.4)	12.7 (12.0-13.4)	< 0.001
Fasting glucose (μmol/L)	5.3 (4.7-5.8)	5.2 (4.5-6.0)	5.3 (4.8-5.7)	0.819
Log10 (HBV-DNA,IU/mL)	-	-	3.3 (0.92-5.9)
Liver histology
Steatosis grade, n (%)¹				< 0.001
S0 (< 5%)	63 (41.4)	0	63 (63.0)
S1 (5%-33%)	44 (28.9)	19 (36.5)	25 (25.0)
S2 (34%-66%)	32 (21.1)	23 (44.2)	9 (9.0)
S3 (≥ 67%)	13 (8.6)	10 (19.2)	3 (3.0)
Fibrosis stage, n (%)¹				0.234
F0	-	28 (53.8)	36 (36.0)
F1	-	13 (25.0)	30 (30.0)
F2	-	6 (11.5)	20 (20.0)
F3	-	4 (7.7)	8 (8.0)
F4	-	1 (1.9)	6 (6.0)
Significant fibrosis(F ≥ 2), n (%)	45 (29.6)	11 (21.2)	34 (34.0)	0.100
Moderate to severe inflammation, n (%)¹³	62 (40.8)	21 (40.4)	41 (41.0)	0.942
FibroScan^® parameters
Controlled attenuation parameter (dB/m)	262 (215-310)	310 (273-347)	236 (199-281)	< 0.001
Liver stiffness measurement (kPa)	7.5 (5.5-12.9)	6.1 (4.8-11.1)	8.0 (5.9-13.9)	0.025

All data are expressed as medians (IQR), or n (%), as appropriate;

¹Either χ² test or Fisher’s exact test was used;

²Mann-Whitney test was used;

³METAVIR grades A2-A3 in patients with viral hepatitis and NAS score ≥ 5 in patients with NAFLD. BMI: Body mass index; WHR: Waist-to-hip ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; γ-GT: γ-glutamyl transpeptidase; HDL-C: High density lipoprotein cholesterol; LDL-C: Low density lipoprotein cholesterol; NAFLD: Non-alcoholic fatty liver disease; CHB: Chronic hepatitis B.

Table 2 Correlation and multivariate linear regression analyses for controlled attenuation parameter with other different parameters

	Spearman correlation		Multivariate linear regression
Parameter	r	P value	OR	95%CI:	P value
BMI	0.49	< 0.001	6.20	2.92-9.48	< 0.001
WHR	0.32	< 0.001	-
ALT	-0.25	0.002	-
AST	-0.25	0.002	-
Albumin	0.27	0.001	-
Total bilirubin	-0.24	0.003	-
Direct bilirubin	-0.17	0.039	-
Total cholesterol	0.18	0.034	-
Triglyceride	0.31	< 0.001	-
LDL-C	0.39	< 0.001	-
Steatosis grade	0.76	< 0.001	37.12	21.63-52.60	< 0.001

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; WHR: Waist-to-hip ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDL-C: Low density lipoprotein cholesterol.

Table 3 Diagnostic accuracy of controlled attenuation parameter and its suggested optimal cut-off values

Steatosis	AUC (95%CI)	P value	Cut-off (dB/m)	Sensitivity (95%CI), %	Specificity (95%CI), %	PPV (95%CI), %	NPV (95%CI), %
S0 vs S1-S3 (≥ 5%)	0.92 (0.88-0.97)	< 0.001	253	88.8 (79.9-94.2)	82.5 (70.5-90.6)	87.8 (78.8-93.4)	83.9 (71.9-91.6)
S0-S1 vs S2-S3 (≥ 34%)	0.92 (0.87-0.97)	< 0.000	285	93.3 (80.7-98.3)	83.2 (74.4-89.5)	70.0 (56.6-80.8)	96.7 (90.1-99.2)
S0-S2 vs S3 (≥ 67%)	0.88 (0.82-0.94)	< 0.001	310	92.3 (62.1-99.6)	79.1 (71.3-85.4)	29.3 (16.6-45.7)	99.1 (94.4-99.9)

AUC: Areas under the curve; PPV: Positive predictive value; NPV: Negative predictive value.

Citation: Shen F, Zheng RD, Mi YQ, Wang XY, Pan Q, Chen GY, Cao HX, Chen ML, Xu L, Chen JN, Cao Y, Zhang RN, Xu LM, Fan JG. Controlled attenuation parameter for non-invasive assessment of hepatic steatosis in Chinese patients. World J Gastroenterol 2014; 20(16): 4702-4711
URL: https://www.wjgnet.com/1007-9327/full/v20/i16/4702.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i16.4702