A Caution in the use of the NAFIC Scoring System as a Diagnostic Screening Tool for Nonalcoholic SteatohepatitisAkinobu Nakamura1, Masato Yoneda2, Yoshio Sumida3, Hideaki Miyoshi1, Atsushi Nakajima4, Tatsuya Atsumi1 and Yasuo Terauchi5*
- *Corresponding Author:
- Yasuo Terauchi, MD, PhD
Professor, Department of Endocrinology and Metabolism
Graduate School of Medicine, Yokohama City University
3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
E-mail: [email protected]
Received date: August 21, 2014; Accepted date: September 12, 2014; Published date: September 18, 2014
Citation: Nakamura A, Yoneda M, Sumida Y, Miyoshi H, Nakajima A, et al. (2014) A Caution in the use of the NAFIC Scoring System as a Diagnostic Screening Tool for Nonalcoholic Steatohepatitis. J Gastroint Dig Syst 4:221. doi:10.4172/2161-069X.1000221
Copyright: © 2014 Nakamura A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: We reinvestigated the clinical usefulness of the NAFIC and modified NAFIC scoring systems in
Japanese patients with nonalcoholic fatty liver disease (NAFLD) according to the presence/absence of obesity.
Methods: A total of 141 Japanese patients with liver-biopsy-confirmed NAFLD were enrolled. All patients were
classified as having nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH) on the basis of Matteoni’s
classification. Obesity was defined as a body mass index of ≥25. To evaluate the overall accuracy of the NAFIC and
modified NAFIC scoring systems, the sensitivity, specificity, positive predictive value (PPV) and negative predictive
value (NPV) of these scoring systems for the diagnosis of NASH were calculated.
Results: In the obese group, the sensitivity, specificity, PPV and NPV of the NAFIC scoring system for the
diagnosis of NASH were 67.3%, 76.2%, 77.8% and 65.3%, respectively, while the corresponding values for the
modified NAFIC scoring systems were 78.8%, 69.0%, 75.9% and 72.5%. On the other hand, in the nonobese group,
the sensitivity, specificity, PPV and NPV of the NAFIC scoring system were 47.1%, 86.7%, 66.7% and 74.3%,
respectively, while those of the modified NAFIC scoring system were 58.8%, 83.3%, 66.7% and 78.1%, respectively.
When the patients were divided by sex, the sensitivity of the NAFIC and modified NAFIC scoring systems in the
female nonobese group were 53.8% and 69.2%, respectively. However, surprisingly, in the male nonobese group,
the sensitivity of both the scoring systems was only 25.0%.
Conclusion: The sensitivity of both the NAFIC and modified NAFIC scoring systems for the diagnosis of NASH
was lower in the male nonobese group than in all the other groups. These findings suggest that caution should be
exercised in the use of the NAFIC scoring system as a diagnostic screening tool for NASH in Japanese patients with
NAFLD, especially male nonobese patients.