Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) may present with increased hepatic fibr osis progressing to end-stage liver disease. No factors that determine incr easing fibrosis and histologically advanced disease have been recognized, t hus, liver biopsy is recommended in all patients for diagnosis and prognosi s. Our aim was to identify independent predictors of severe hepatic fibrosi s in patients with NASH. One hundred and forty-four patients were studied. All patients underwent liver biopsy. Clinical and biochemical variables wer e examined with univariate and multivariate analysis. Thirty-seven (26%) pa tients had no abnormal fibrosis, 53 (37%) had mild fibrosis, 15 (10%) had m oderate fibrosis, 14 (10%) had bridging fibrosis, and 25 (17%) had cirrhosi s. In multivariate analysis, older age (P = .001), obesity (P = .002), diab etes mellitus (P = .009), and aspartate transaminase/alanine transaminase ( AST/ALT) ratio greater than I (P = .03) were significant predictors of seve re liver fibrosis (bridging/cirrhosis). Body mass index (P = .003) was the only independent predictor of the degree of fat infiltration. Increased tra nsferrin saturation correlated positively with the severity of fibrosis (P = .02) in univariate analysis, and there was a trend for more female patien ts among those,vith more advanced fibrosis (P = .09). However, iron studies or gender were not significant when controlled for age, obesity, diabetes, and AST/ALT ratio. In conclusion, older age, obesity, and presence of diab etes mellitus help identify those NASH patients who might have severe liver fibrosis. This is the subgroup of patients with NASH who would be expected to derive the most benefit from having a liver biopsy and considering inve stigational therapies.