Applicability for all NAFLD cases, diverse ethnic populations, and logistics/ low cost are other issues. To provide higher diagnostic accuracy with readily available tests, we explored conventional and extended clinicopathological variables, LSM and biomarkers, then combined modalities in a clinical model to stratify as many as possible NAFLD cases into advanced or no fibrosis, and also to identify NASH versus simple steatosis. Patients and Methods: From our combined clinical database of 200 biopsied NAFLD patients (steatosis ≥5%), 169 with LSM data were analyzed: 135 from Hong Kong, 18 Perth, 16 Canberra. A further
18 cases were excluded due to missing data (final n = 151). According to NAFLD activity score (0–3 = simple steatosis, 4 = excluded, 5–8 = NASH) and Brunt’s fibrosis score (0, 1 or 2, 3 or 4), cases were grouped into 3 categories Z-VAD-FMK nmr (simple steatosis, NASH, F3/4 [NB, this third category could include NASH or “not NASH” NAFLD). Biomarkers included: serum ferritin, M30 (apoptosis GPCR Compound Library solubility dmso marker), M65ed (overall cell death marker), hyaluronic acid (HA), P3NP, annexin V-positive microparticles (MP), and genetic predisposition (PNPLA3). Using generalized linear models in SPSS v22.0, a parsimonious
decision tree was created to predict the three NAFLD categories. Results: Age, waist circumference (not BMI), hypertension, diabetes/fasting blood
glucose, ALT, platelet count, INR, LSM, all biomarkers except ferritin, and NAFLD fibrosis score significantly correlated with NAFLD category. In the multivariate analysis of the above candidate indicators, LSM was found to be the dominant predictor (OR 1.22, 95% CI 1.09–1.34, p < 0.0001). Consequently, LSM was stratified into 3 bands (<5.8, 5.8–30.3, >30.3 kPa) to maximize NAFLD category discrimination. Within each LSM stratum, the candidate variables were used 3-mercaptopyruvate sulfurtransferase to further predict NAFLD categories. The significant factors entering the decision tree were P3NP (cut-off 8.7 ng/mL), ALT (cut-off of 55 U/L within the lower band, and 60 U/L within the middle LSM stratum), hypertension and LSM< or >10. Overall, 72% (109/151) agreement between predicted and histologically-observed NAFLD categories was found across the tree. The sensitivities and specificities varied by LSM band. For LSM < 5.8 kPa (27 SS, 22 NASH, 1 F3/F4), achieved sensitivity for simple steatosis was 89% (24/27), and sensitivity for NASH was 55% (12/22), with predictive values of 71% and 80%, respectively. In contrast, the middle LSM band (LSM 5.8–30.3 kPa, [25 SS, 48 NASH, 23 F3/F4]) achieved 81% (39/48) sensitivity for NASH and 40% (10/25) for simple steatosis, with predictive values of 67% and 100%, respectively.