To identify those patients with NASH, an elevated NAS, and significant fibrosis, the best fitting multivariable logistic regression model was identified and internally validated using boot-strapping. Liver stiffness measurement (LSM) by vibration-controlled transient elastography and controlled attenuation parameter (CAP) measured by FibroScan device were combined with aspartate aminotransferase (AST), alanine aminotransferase (ALT), or AST:ALT ratio. This was a prespecified secondary outcome of a study for which the primary endpoints have already been reported. The derivation cohort was a cross-sectional, multicentre study of patients aged 18 years or older, scheduled to have a liver biopsy for suspicion of NAFLD at seven tertiary care liver centres in England. This prospective study included a derivation cohort before validation in multiple international cohorts. We aimed to develop a score to identify patients with NASH, elevated NAFLD activity score (NAS≥4), and advanced fibrosis (stage 2 or higher ). The burden of non-alcoholic fatty liver disease (NAFLD) is increasing globally, and a major priority is to identify patients with non-alcoholic steatohepatitis (NASH) who are at greater risk of progression to cirrhosis, and who will be candidates for clinical trials and emerging new pharmacotherapies. 20 Radcliffe Department of Medicine, University of Oxford, Oxford, UK.19 Medical Affairs Department, Echosens, Paris, France.18 Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK Liverpat, Paris, France.17 Pathology Department, Hôpital Beaujon, APHP, Clichy, France.16 NIHR Oxford Biomedical Research Centre and Oxford Liver Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.15 NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. 14 Institute of Translational and Stratified Medicine, University of Plymouth, Plymouth, UK.13 Institute of Cellular Medicine-Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.12 UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.11 Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.10 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.9 NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.8 Department of Nutrition, Hôpital Européen Georges-Pompidou (APHP), University of Paris, Paris, France.7 Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.6 Gastroenterology and Hepatology Unit, Gastrointestinal Endoscopy Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.5 Department of Hepato-Gastroenterology, Angers University Hospital, Angers, France HIFIH Laboratory UPRES EA3859, SFR4208, Angers University, Angers, France.4 Brooke Army Medical Center, Fort Sam Houston, TX, USA Uniformed Services University of the Health Sciences, Bethesda, MD, USA.3 National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.Electronic address: 2 R&D Department, Echosens, Paris, France. 1 National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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