κ scores reflecting agreement between the four sets of NASH pathologic criteria are summarized in Table 3. Specifically, the diagnoses of NASH by the original criteria for NAFLD

subtypes and the diagnoses of LY294002 concentration NASH by the current study’s criteria were in almost perfect agreement κ = 0.896 [95% confidence interval (CI) = 0.838-0.953]. The agreement of NASH diagnoses by the original criteria for NAFLD subtypes and by the current study’s NASH protocol with NASH diagnoses by NAS ≥ 5 (the threshold for diagnosing NASH) was moderate [κ = 0.470 (95% CI = 0.367-0.574) and κ = 0.511 (95% CI = 0.409-0.613), respectively]. However, the agreement of the Brunt criteria (any grade of NASH) with the current study’s NASH criteria [κ = 0.365 (95% CI = 0.257-0.474] and with the original criteria for NAFLD subtypes [κ = 0.441 (95% CI = 0.329-0.552)] was fair to moderate, and its agreement with NAS ≥ 5 was relatively poor [κ = 0.178 (95% CI = 0.117-0.240)].

Our data also show that using NAS ≥ 5 for establishing the diagnosis of NASH missed 40% to 45% of the NASH patients diagnosed by the current study’s NASH criteria and by the original criteria for NAFLD subtypes. In fact, only 72 of 131 patients diagnosed with NASH by the original criteria for NAFLD subtypes and 75 of 123 Selleckchem LDK378 patients diagnosed by the current study’s NASH criteria were also diagnosed with NASH by an NAS value of 5 or higher. On the other hand, in comparison with the current study’s NASH criteria and the original PAK5 criteria for NAFLD subtypes, another 30% of NAFLD patients were considered to have NASH according to the Brunt criteria. In fact, all these patients were diagnosed to have grade 1 NASH by the Brunt criteria. In order to test whether a better agreement could be achieved with a different NAS threshold, NAS values ≥ 3 and ≥ 4 were separately considered as definitions of NASH. Lowering

the NAS threshold improved the agreement of the NAS criteria with the original criteria for NAFLD subtypes and with the current study’s NASH criteria [κ = 0.645 (95% CI = 0.544-0.746) and κ = 0.564 (95% CI = 0.457-0.672) for the NAS threshold of 3 and κ = 0.600 (95% CI = 0.502-0.698) and κ = 0.602 (95% CI = 0.504-0.701) for the NAS threshold of 4, respectively]. Despite this improvement in κ scores, the agreement remained moderate. On the other hand, assessing the agreement between different protocols for the fibrosis stage, we were able to show that the NAS fibrosis scores and the current study’s fibrosis scores were in excellent agreement [nonparametric correlation coefficient = 0.74 (P < 0.0001) for pericellular fibrosis and nonparametric correlation coefficient = 0.83 (P < 0.0001) for portal fibrosis]. Regardless of which criteria were used to establish the diagnosis of NASH (with the exception of the Brunt criteria), patients with the pathologic diagnosis of NASH had higher LRM than those with non-NASH NAFLD (Table 4).