Campos et al developed a clinical scoring system for predicting nonalcoholic steatohepatitis (NASH) in morbidly obese patients. This can help to identify a patient who may benefit from more aggressive clinical management. The authors are from the University of California at San Francisco.
Patient selection: adult (>= 18 years of age), morbidly obese, undergoing elective bariatric surgery, negative for alcohol abuse, viral hepatitis and other causes of liver disease
Parameters:
(1) hypertension
(2) Type 2 diabetes mellitus
(3) obstructive sleep apnea
(4) race
(5) serum AST in IU/L
(6) serum ALT in IU/L
|
Parameter |
Finding |
Points |
|
hypertension |
absent |
0 |
|
|
present |
1 |
|
Type 2 diabetes |
absent |
0 |
|
|
present |
1 |
|
obstructive sleep apnea |
absent |
0 |
|
|
present |
1 |
|
race |
Black |
0 |
|
|
other |
2 |
|
serum AST |
< 27 IU/L |
0 |
|
|
>= 27 IU/L |
1 |
|
serum ALT |
< 27 IU/L |
0 |
|
|
>= 27 IU/L |
1 |
total clinical score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the greater the likelihood of NASH.
|
Total Score |
Risk of NASH |
Prevalence of NASH |
|
0, 1 or 2 |
low |
< 15% |
|
3 or 4 |
intermediate |
15 to 49% |
|
5 |
high |
50 to 79% |
|
6 or 7 |
very high |
>= 80% |
Limitation:
• The methods of measuring serum AST and ALT were not mentioned. The normal reference ranges were also not defined. A patient with NASH may have serum transaminases within the normal reference range.
Specialty: Gastroenterology, Nutrition
