Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD

Abstract

Background/Aims:This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China.Methods:A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods.Results:ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. –3.09 ± 3.89, p < 0.001). With a cut-off value of –0.22, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of diagnosed ALD cases was 87.1%, 92.5%, and 0.934 (95% confidence interval [CI], 0.879 to 0.969), respectively. The corresponding values for aspartate aminotransferase (AST)/alanine transaminase (ALT), mean corpuscular volume (MCV), and GGT were 75.29%, 72.94%, and 0.826 (95% CI, 0.752 to 0.885); 94.34%, 83.02%, and 0.814 (95% CI, 0.739 to 0.875) and 80.23%, 79.25%, and 0.815 (95% CI, 0.740 to 0.876), respectively. ANI AUROC was significantly higher than the AST/ALT, MCV, or GGT AUROCs (all p < 0.001), moreover, ANI showed better diagnostic performance. The combination of ANI and GGT showed a better AUROC than ANI alone (0.976 vs. 0.934, p = 0.016). The difference in AUROCs between AST/ALT, MCV, and GGT was not statistically significant (all p > 0.05).Conclusions:ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.

Burden of Alcoholic Liver Disease in a Tertiary Care Center: A Descriptive Cross-sectional Study

“…19 The De-ritis ratio was higher in patients with ALD (2.49±0.8) than that of NAFLD (0.87±0.27). Serum AST level was significantly higher than ALT in ALD groups which gave rise to higher De-ritis ratio, and this was similar to the studies done by Ram, et al 21 Junking, et al 1 Serum ALT is usually higher than AST in most causes of liver damage, but AST remains significantly higher in case of ALD. This might be because AST is a mitochondrial enzyme, acetaldehyde and free radicals produced during ethanol metabolism can lead to oxidative stress and lipid peroxidation causing mitochondrial injury which results in leakage of AST in the circulation as mAST is the more prevalent isoenzyme with approximately 80% of total AST activity in human liver contributed by mAST.…”

“…Studies have shown that GGT has higher predictive value of ALD. 1,18,20 Increase in serum levels of ALP along with GGT suggests a liver pathology. 19 The De-ritis ratio was higher in patients with ALD (2.49±0.8) than that of NAFLD (0.87±0.27).…”

“…Fatty Liver Disease (FLD) is a common disease which can be subdivided according to its cause into: alcoholic fatty liver disease, a type of alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). 1 ALD is a general term used to refer to a spectrum of alcohol-related liver injuries including fatty liver, alcoholic hepatitis and alcoholic cirrhosis, 2 whereas NAFLD is a spectrum of liver diseases characterized by the presence of ectopic fat in the liver, which cannot be explained by alcohol consumption resulting in simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. 3 Alcohol is a well established hepatotoxin whose consumption is always associated with risk of development of ALD, with no absolute threshold of alcohol consumption necessary for the development of liver injury.…”

Hepatoprotective Effects of a Functional Formula of Three Chinese Medicinal Herbs: Experimental Evidence and Network Pharmacology-Based Identification of Mechanism of Action and Potential Bioactive Components

“…Liver diseases, affecting more than 10% of the world population, remains one of the most serious public health concerns worldwide [ 1 ]. Among the various forms of liver disease, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are the two most common types with high prevalence around the world [ 2 ]. ALD, resulting from chronic excessive alcohol consumption, is one of the most important causes of liver-related death, accounting for an estimated 3.8% of global mortality [ 3 ].…”

A Biomedical Investigation of the Hepatoprotective Effect of Radix salviae miltiorrhizae and Network Pharmacology-Based Prediction of the Active Compounds and Molecular Targets

“…ALD is caused by excessive alcohol consumption whereas NAFLD is related with obesity and metabolic disorders, although nonalcoholic steatohepatitis (NASH) has been reported in lean individuals [3]. Both ALD and NAFLD may progress into fibrosis, cirrhosis, and eventually hepatocellular carcinoma as a result of severe and prolonged liver damage [4]. The effect of current synthetic agents in treating ALD and NAFLD is not satisfactory and most of them have undesirable side effects [5].…”