Table 1. Patients’ characteristics
Clinical characteristics
|
|
Female, n (%)
|
64 (57)
|
Age, years*
|
63 (20-84)
|
Body mass index, kg/m2*
|
28.0 (18.8-38.5)
|
Diabetes, n (%)
|
75 (66)
|
Hypertension, n (%)
|
63 (56)
|
Laboratory tests
|
|
Platelet count, ×103/µL*
|
194 (59-637)
|
PT-INR
|
1.05 (0.91-1.49)
|
AST, U/L*
|
54 (15-259)
|
ALT, U/L*
|
53 (14-324)
|
ALP, U/L*
|
233 (106-818)
|
γGT, U/L*
|
61.5 (14-751)
|
T-BIL, mg/dL*
|
0.9 (0.4-2.2)
|
Total protein, g/dL*
|
7.1 (5.9-8.1)
|
Albumin, g/dL*
|
4.1 (3.2-5.0)
|
TC, mg/dL*
|
179 (109-275)
|
HDL-C, mg/dL*
|
46.5 (27-75)
|
LDL-C, mg/dL*
|
113 (42-198)
|
TG, mg/dL*
|
139 (38-513)
|
FPG, mg/dL*
|
107 (79-249)
|
T4C7s, ng/mL*
|
5.6 (2.6-14.0)
|
Ferritin, ng/dL*
|
245 (16-874)
|
Pathological findings
|
|
Steatosis score 1/2/3, n
|
73/29/11
|
Lobular inflammation score 0/1/2/3, n
|
5/76/26/6
|
Ballooning score 0/1/2, n
|
46/39/28
|
Fibrosis stage 0/1/2/3/4, n
|
18/37/20/35/3
|
Ultrasonographical findings
|
|
LSM, kPa*
|
8.8 (3.6-30.7)
|
CAP, dB/m*
|
283 (149-386)
|
SCD, mm*
|
19.9 (10.4-25.0)
|
*Data are shown as n, n (%), or median (range). Abbreviations: PT-INR, prothrombin time–international normalized ratio; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; γGT, γ-glutamyl transpeptidase; T-BIL, total bilirubin; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; FPG, fasting plasma glucose; T4C7s, type Ⅳ collagen 7s; LSM, liver stiffness measurement; CAP, controlled attenuation parameter; SCD, skin–capsular distance
Table 2. Correlations of various parameters with CAP
|
ρ*
|
P value
|
Age
|
-0.100
|
0.292
|
Body mass index
|
0.171
|
0.067
|
Platelet count
|
0.106
|
0.263
|
PT-INR
|
-0.094
|
0.327
|
AST
|
-0.065
|
0.497
|
ALT
|
-0.008
|
0.937
|
ALP
|
-0.042
|
0.656
|
γGT
|
0.038
|
0.692
|
T-BIL
|
-0.008
|
0.931
|
Total protein
|
-0.040
|
0.677
|
Albumin
|
0.245
|
0.009
|
TC
|
0.069
|
0.470
|
HDL-C
|
-0.160
|
0.096
|
LDL-C
|
0.082
|
0.392
|
TG
|
0.097
|
0.308
|
FPG
|
0.151
|
0.111
|
T4C7s
|
-0.098
|
0.312
|
Ferritin
|
0.115
|
0.229
|
LSM
|
-0.022
|
0.815
|
SCD
|
0.329
|
< 0.001
|
*Spearman’s correlation coefficient
Abbreviations: PT-INR, prothrombin time–international normalized ratio; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; γGT, γ-glutamyl transpeptidase; T-BIL, total bilirubin; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; FPG, fasting plasma glucose; T4C7s, type Ⅳ collagen 7s; SCD, skin–capsular distance
Table 3. Single regression analysis for factors associated with CAP
|
B*
|
SE
|
P value
|
Age
|
-0.328
|
0.282
|
0.248
|
Gender Male
|
-8.470
|
3.775
|
0.027
|
Body mass index
|
1.883
|
0.907
|
0.040
|
Platelet count
|
0.075
|
0.048
|
0.120
|
PT-INR
|
-36.407
|
45.660
|
0.427
|
AST
|
-0.042
|
0.104
|
0.686
|
ALT
|
0.017
|
0.077
|
0.826
|
ALP
|
-0.028
|
0.037
|
0.451
|
γGT
|
-0.001
|
0.034
|
0.966
|
T-BIL
|
-1.830
|
10.463
|
0.862
|
Total protein
|
-1.967
|
7.844
|
0.802
|
Albumin
|
32.724
|
10.309
|
0.002
|
TC
|
0.080
|
0.106
|
0.453
|
HDL-C
|
-0.643
|
0.339
|
0.060
|
LDL-C
|
0.159
|
0.121
|
0.194
|
TG
|
0.077
|
0.045
|
0.088
|
FPG
|
0.201
|
0.123
|
0.106
|
T4C7s
|
-2.354
|
1.812
|
0.197
|
Ferritin
|
0.019
|
0.019
|
0.327
|
Steatosis score
|
15.537
|
5.560
|
0.006
|
Lobular inflammation score
|
-6.974
|
6.001
|
0.248
|
Ballooning score
|
-12.061
|
4.684
|
0.011
|
Fibrosis stage
|
-4.444
|
3.328
|
0.185
|
LSM
|
-0.427
|
0.626
|
0.497
|
SCD
|
4.641
|
1.142
|
< 0.001
|
*Partial regression coefficient. Abbreviations: SE, standard error; SCD, skin–capsular distance; PT-INR, prothrombin time–international normalized ratio; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; γGT, γ-glutamyl transpeptidase; T-BIL, total bilirubin; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; FPG, fasting plasma glucose; T4C7s, type Ⅳ collagen 7s
Table 4. Multiple regression analysis for factors associated with CAP
|
B*
|
β**
|
SE
|
P value
|
Model 1
|
|
|
|
|
Steatosis score
|
19.268
|
0.318
|
5.135
|
< 0.001
|
SCD
|
5.260
|
0.408
|
1.093
|
< 0.001
|
Model 2
|
|
|
|
|
Steatosis score
|
20.233
|
0.334
|
5.223
|
< 0.001
|
SCD
|
6.110
|
0.474
|
1.380
|
< 0.001
|
Body mass index
|
-1.041
|
-0.107
|
1.032
|
0.3151
|
Model 3
|
|
|
|
|
Steatosis score
|
18.559
|
0.306
|
5.009
|
< 0.001
|
SCD
|
5.353
|
0.415
|
1.337
|
< 0.001
|
Body mass index
|
-0.680
|
-0.070
|
0.994
|
0.495
|
Gender, male
|
-3.922
|
-0.096
|
3.363
|
0.246
|
Albumin
|
25.770
|
0.227
|
9.526
|
0.008
|
Ballooning score
|
-4.807
|
-0.095
|
4.334
|
0.270
|
Multiple regression analysis of individual models. *Partial regression coefficient and **standard partial regression coefficient. Abbreviations: SE, standard error; SCD, skin–capsular distance
Table 5. Cut-off values of original and modified CAP for detecting steatosis score of ≥2
|
|
Cut-off (dB/m)
|
Se
|
Sp
|
PPV
|
NPV
|
YI
|
Original
|
269
|
85.0
|
46.6
|
46.6
|
85.0
|
Adjusted
|
165
|
85.0
|
47.9
|
47.2
|
85.4
|
Se ≥ 90%
|
Original
|
258
|
90.0
|
32.9
|
42.4
|
85.7
|
Adjusted
|
161
|
90.0
|
41.1
|
45.6
|
88.2
|
Sp ≥ 90%
|
Original
|
335
|
12.5
|
90.4
|
41.7
|
65.3
|
Adjusted
|
220
|
22.5
|
90.4
|
56.3
|
68.0
|
All values are shown as percentages. Abbreviations: CAP, controlled attenuation parameter; YI, Youden’s index; Se, sensitivity; Sp, specificity