A novel pathophysiologicalbased panel of biomarkers for the diagnosis of nonalcoholic steatohepatitis

Non-invasive biochemical markers are useful to distinguish between nonalcoholic steatohepatitis (nash) and simple steatosis. the aim of this study was to test the diagnostic value of a panel of biomarkers derived from the pathophysiological events involved in the development of nash. a total of 79 patients: 20 not-nash and 59 nash were included in the study. definitive nash was defined according to kleiner's classification. in all subjects,parameters of the metabolic syndrome,insulin resistance (homair),adiponectin,interleukin-6 (il-6) and total cytokeratin-18 (m65 antigen) were determined. univariate and multivariate analysis were used to identify independent predictors of nash. in multivariate analysis three markers were independently predictors of nash: adiponectin,il-6 and m65 levels. in decreasing order,the independent predictors of nash (nas≥5) were m65 with an auroc of 0.791,il-6 with an auroc of 0.727 and adiponectin with an auroc of 0.709. the combination of two biomarkers yelded an auroc of 0.828 for m65 and il-6,0.841 for adiponectin and m65 and 0.852 for adiponectin and il-6. the best value was obtained by triple combination: adiponectin,m65 and il-6 with and auroc of 0.903,sp=85.7% (ppv=94.2%) and se=84.5% (npv=66.7%). in conclusion,a novel pathophysiological based panel of biomarkers combining total ck-18,il-6 and adiponectin may be useful to predict nash.