A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients

Aliment Pharmacol Ther. 2010 Dec;32(11-12):1315-22. doi: 10.1111/j.1365-2036.2010.04480.x. Epub 2010 Oct 7.


Background: Non-invasive approaches are useful to differentiate simple steatosis from non-alcoholic steatohepatitis (NASH) in obese and morbidly obese patients.

Aim: To develop a new scoring system to diagnose definitive NASH.

Methods: Preoperative clinical and biological data including serum caspase 3-generated cytokeratin-18 fragments (CK18) and surgical liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group (n = 310) and validation group (n = 154). Definitive NASH was defined according to Kleiner's classification with a Non-alcoholic fatty liver disease Activity Score (NAS) ≥5.

Results: Alanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome were independent predictors for discriminating patients with NAS ≥5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS ≥5. Whereas serum CK18 fragment alone had an area under the receiver operating characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training group and the validation group, respectively.

Conclusion: A simple and non-invasive composite model (the Nice Model) including metabolic syndrome, ALT and CK18 fragments is able to predict accurately a non-alcoholic fatty liver disease activity score ≥5 in morbidly obese subjects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alanine Transaminase*
  • Body Mass Index
  • Case-Control Studies
  • Fatty Liver / diagnosis*
  • Fatty Liver / etiology
  • Female
  • Humans
  • Keratin-18*
  • Liver Function Tests
  • Male
  • Metabolic Syndrome / complications*
  • Middle Aged
  • Models, Biological
  • Obesity, Morbid / complications*
  • Predictive Value of Tests
  • Risk Factors
  • Statistics as Topic


  • Keratin-18
  • Alanine Transaminase