A Simple Index for Nonalcoholic Steatohepatitis—HUFA—Based on Routinely Performed Blood Tests

Abstract

Background and objectives: Data suggests that nearly 30% of the general population have steatosis and up to 5% of this population develops nonalcoholic steatohepatitis (NASH). Liver biopsy is still considered to be the gold standard for the diagnosis of NASH. Great effort is being made toward the identification of sensitive diagnostic tests that do not involve invasive procedures to address a common concern in patients with the nonalcoholic fatty liver disease—whether they have NASH or simple steatosis. We aimed to investigate the independent predictors and develop a non-invasive, easy-to-perform, low-cost set of parameters that may be used in clinical practice to differentiate simple steatosis from NASH. Methods: А cross-sectional study of nonalcoholic fatty liver disease (NAFLD) patients divided into two groups: group I—simple steatosis (SS) and group II—biopsy-proven NASH. Strict inclusion criteria and stepwise analysis allowed the evaluation of a vast number of measured/estimated parameters. Results: One hundred and eleven patients were included—82 with simple steatosis and 29 with biopsy-proven NASH. The probability of NASH was the highest when homeostatic model assessment of insulin resistance (HOMA-IR) was above 2.5, uric acid above 380 µmol/L, ferritin above 100 µg/L and ALT above 45 U/L. An acronym of using first letters was created and named the HUFA index. This combined model resulted in an area under the receiver operator characteristic curve (AUROC) of 0.94, provided sensitivity, specificity, positive predictive value and a negative predictive value for NASH of 70.3%, 95.1%, 83.1% and 90.0%, respectively. Conclusion: We suggest a simple non-invasive predictive index HUFA that encompasses four easily available parameters (HOMA-IR, uric acid, ferritin and ALT) to identify patients with NASH, which may reduce the need for a liver biopsy on a routine basis in patients with NAFLD.

Relationship between Serum Uric Acid Levels and Nonalcoholic Fatty Liver Disease in Non-Obese Patients

“…Its level in blood can increase with insulin resistance, atherosclerosis, hypertension, and obesity. The factors resulting in this relationship are hypothesized to be inflammation and oxidative stress [9,26]. Moreover, an increasing amount of data suggests a link between UA and NAFLD.…”

“…Moreover, an increasing amount of data suggests a link between UA and NAFLD. Many recent observations were done in order to elaborate on this connection [8,9,13,26,27,28,29]. It can be said that this connection is strengthened by studies that used xanthine oxidase inhibitors on animals in order to decrease UA production.…”

<p>Correlation Between Serum Uric Acid Level and Central Body Fat Distribution in Patients with Type 2 Diabetes</p>

“…14 Non-alcoholic fatty liver disease (NAFLD) is a serious manifestation of visceral fat accumulation. 15,16 In 1,365 obese adults, Liu et al reported that SUA level independently correlated with the risk of NAFLD. 17 After 6 years of follow-up in 14,442 healthy adults, Yang et al found that 29.2% of participants developed new metabolic diseases with NAFLD being the main risk factor.…”

Male zooid extracts of Antheraea pernyi ameliorates non-alcoholic fatty liver disease and intestinal dysbacteriosis in mice induced by a high-fat diet

“…Apart from lipogenesis and dyslipidemia, the pathogenesis of NAFLD was closely linked to oxidative stress and inflammation ( Culafic et al., 2019 ). A close positive correlation exists between the total antioxidant capacity of the body’s defense system and health ( Zhang et al., 2021 ).…”