We subsequently calculated the AUROC to estimate the diagnostic performance of serum ferritin for detecting presence of fibrosis. For stage 1–4 liver diseases, it was found to be 0.617 (optimal cut-off value, 208.8 ng/mL; sensitivity, 49.2%; specificity, 69.7%; positive predictive value, 87.4%; negative predictive value, 24.3%)

(Fig. 1a). The AUROC calculated to estimate the diagnostic performance of the serum ferritin for detecting severe fibrosis (stage 2–4) in NAFLD patients was 0.573 (optimal cut-off value, 295.5 ng/mL; sensitivity, 34.1%; specificity, 72.1%; positive predictive value, 59.1%; negative predictive value, 55.4%) (Fig. 1b). Finally, the AUROC for detecting advanced fibrosis (stages 3, 4) was 0.554 (optimal cut-off value, 301.0 ng/mL; sensitivity, 33.5%; specificity, Selleck Alvelestat 74.8%; positive predictive value, 27.7%; negative predictive value, 79.6%) (Fig. 1c). In this study, similar to data presented in Angulo et al., the sensitivity and positive predictive value were not high enough to predict severe and advanced fibrosis in NAFLD patients utilizing serum ferritin alone. We previously reported that serum ferritin concentration selleck kinase inhibitor was significantly higher in patients with NASH as compared to patients

with NAFL. However, we also demonstrated that the sensitivity was not high enough to rule out NASH utilizing serum ferritin alone.[4] Therefore, we developed a new scoring system that includes ferritin and two other additional clinical laboratory parameters.[10] The results presented here reconfirm that measurement of serum ferritin levels alone demonstrate low diagnostic accuracy (AUROC, <0.60) for detecting severe or advanced

fibrosis even if patients have significantly high serum ferritin levels. Ferritin is reported to be associated with systemic Farnesyltransferase inflammation, and often it is associated with chronic inflammatory disease states such as diabetes and obesity.[11] Furthermore, we reported that serum ferritin is associated with visceral fat area, subcutaneous fat area and degree of fatty liver.[12] In this study, several factors such as sex differences, steatosis, inflammation and ballooning hepatocytes as well as fibrotic stage are suggested to affect the serum ferritin levels. In general, unlike viral hepatitis, NAFLD may have two aspects: steatosis and fibrosis. Therefore, in NAFLD patients, it may be difficult to assess liver fibrosis by serum ferritin levels alone. Because the incidence of NAFLD is rising rapidly in both adults and children, simple non-invasive methods for detecting fibrosis in these patients is of major clinical interest. However, we assert that because some clinicians use ferritin as a biomarker for the severity of fibrosis, they should be vigilant in its appropriate use to avoid missing subsequent progression of liver disease.