Evaluation of controlled attenuation parameter in assessing hepatic steatosis in patients with autoimmune liver diseases

Table 1 Baseline patient characteristics

Variable	All (n = 190)	AILDs (n = 114)	NAFLD (n = 66)
Age, yr	46.36 ± 12.82	48.72 ± 11.57	42.15 ± 13.80
Male sex, n (%)	45 (23.68)	23 (20.18)	18 (27.27)
BMI, kg/m2	23.97 ± 2.69	24.33 ± 1.80	23.63 ± 2.34
Prevalence of autoantibodies, n (%)	134 (70.53)	89 (78.07)	37 (56.06)
Laboratory
AST, U/L	63.96 ± 86.42	72.54 ± 102.23	54.6 ± 59.10
ALT, U/L	83.86 ± 86.42	81.98 ± 92.78	92.81 ± 78.67
LDH, U/L	182.70 ± 35.43	183.02 ± 37.39	182.64 ± 32.86
AKP, U/L	80.00 (63.00, 108.50)	85.00 (62.25, 129.5)	75.00 (64.00, 94.00)
GGT, U/L	103.67 ± 126.83	126.00 ± 151.92	76.82 ± 73.15
Total bilirubin, mg/dL	10.90 (8.10, 15.30)	11.20 (8.30, 16.70)	9.80 (6.95, 14.15)
Direct bilirubin, mg/dL	3.60 (2.80, 4.90)	3.70 (2.90, 5.70)	3.45 (2.52, 4.50)
Histological steatosis stage, n (%)
S0 (< 5%)	22 (11.6)	20 (11.1)	0 (0.0)
S1 (5%-33%)	85 (44.7)	61 (33.9)	16 (24.2)
S2 (> 33%-66%)	55 (28.9)	28 (15.6)	27 (40.9)
S3 (> 66%)	28 (14.7)	5 (2.8)	23 (34.8)
Histological fibrosis stage, n (%)
F0 (no fibrosis)	12 (6.3)	1 (0.9)	10 (15.2)
F1 (portal fibrosis without septa)	70 (36.8)	38 (33.3)	30 (45.5)
F2 (portal and periportal fibrosis with few septa)	64 (33.7)	40 (35.1)	18 (27.3)
F3 (portal and periportal fibrosis with numerous septa without cirrhosis)	35 (18.4)	26 (22.8)	8 (12.1)
F4 (cirrhosis)	9 (4.7)	9 (7.9)	0 (0.0)
CAP, dB/m	270.17 ± 54.52	261.73 ± 53.80	290.97 ± 50.68
LSM, kPa	7.66 ± 5.57	8.48 ± 6.50	6.61 ± 3.66

Distributions are expressed as the mean ± SD or median (interquartile range) or number (percentage). AIH: Autoimmune hepatitis; NAFLD: Nonalcoholic fatty liver disease; BMI: Body mass index; AKP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CAP: Controlled attenuation parameter; GGT: Gamma-glutamyl transferase; LDH: Lactate dehydrogenase; LSM: Liver stiffness measurement.

Table 2 Diagnostic performance of controlled attenuation parameter for assessment of hepatic steatosis in patients with mixed etiology liver disease and in patients with autoimmune liver diseases

Etiology	Grade	AUROC (95%CI)	Cut-off, dB/m (kPa)	Sensitivity	Specificity	PPV	NPV
Mixed etiology	S ≥ 1	0.883 (0.807-0.958)	229	0.852	0.714	0.960	0.375
	S ≥ 2	0.772 (0.705-0.838)	259	0.875	0.636	0.636	0.875
	S = 3	0.732 (0.640-0.824)	283.5	0.750	0.654	0.273	0.938
AILDs	S ≥ 1	0.878 (0.791-0.965)	220.5	0.874	0.737	0.937	0.538
	S ≥ 2	0.764 (0.676-0.853)	271.5	0.818	0.704	0.510	0.937
	S = 3	0.821 (0.716-0.926)	283.5	1.000	0.688	0.128	1.000

AUROC: Area under receiver operating characteristic; CAP: Controlled attenuation parameter; NPV: Negative predictive value; PPV: Positive predictive value.

Table 3 Comparative analysis of patients with autoimmune hepatitis concomitant with nonalcoholic fatty liver disease and patients with nonalcoholic fatty liver disease with autoimmune phenomena

Variable	Patients with AIH concomitant with NAFLD (n = 61)	Patients with NAFLD with autoimmune phenomena (n = 34)	P value
Age, yr	52.05 ± 11.11	43.68 ± 13.71	< 0.001
Male sex, n (%)	13 (21.3)	6 (17.6)
BMI, kg/m2	24.21 ± 3.10	24.65 ± 2.02
Laboratory
AST, U/L	55.03 ± 47.31	50.03 ± 29.26
ALT, U/L	66.62 ± 74.94	86.01 ± 62.59
AKP, U/L	63.00 (45.00, 84.00)	75.00 (54.00, 87.00)
GGT, U/L	49.27 ± 32.24	69.26 ± 44.07	< 0.05
Total bilirubin, mg/dL	10.20 (8.60, 14.10)	10.25 (7.40, 13.67)
Direct bilirubin, mg/dL	4.20 (3.20, 5.00)	3.70 (2.92, 4.65)
IgG	15.60 ± 4.57	13.81 ± 2.67	< 0.05
IgM	1.18 ± 0.45	1.28 ± 0.57
Histological steatosis stage, n (%)
S1	39 (63.9)	8 (23.5)
S2	17 (27.9)	10 (29.4)
S3	5 (8.2)	16 (47.1)
Histological fibrosis stage, n (%)
F1	17 (27.9)	6 (17.6)
F2	22 (36.1)	14 (41.2)
F3	16 (26.2)	11 (32.4)
F4	6 (9.8)	3 (8.8)
CAP, dB/m	272.57 ± 44.39	293.41 ± 51.04	< 0.05
LSM in total, kPa	9.34 ± 7.14	6.49 ± 2.44	< 0.05
In steatosis S1	9.19 ± 8.11	5.28 ± 1.88	< 0.05
In steatosis S2	7.80 ± 3.47	6.31 ± 2.18
In steatosis S3	15.76 ± 6.25	7.20 ± 2.69	< 0.01

Distributions are expressed as the mean ± SD or median [interquartile range] or number (percentage). AKP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; CAP: Controlled attenuation parameter; GGT: Gamma-glutamyl transferase; LSM: Liver stiffness measurement; AIH: Autoimmune hepatitis; NAFLD: Nonalcoholic fatty liver.