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Title: The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study
Authors: Neeraj Bhala
Paul Angulo
David van der Poorten
Eric Lee
Jason M. Hui
Giorgio Saracco
Leon A. Adams
Phunchai Charatcharoenwitthaya
Joanne H. Topping
Elisabetta Bugianesi
Christopher P. Day
Jacob George
Nuffield Department of Clinical Medicine
John Radcliffe Hospital
The University of Sydney
University of Kentucky Chandler Medical Center
Mayo Clinic
Universita degli Studi di Torino
University of Western Australia Faculty of Medicine and Dentistry
Mahidol University
Alma Mater Studiorum University
Newcastle University, United Kingdom
Keywords: Medicine
Issue Date: 1-Oct-2011
Citation: Hepatology. Vol.54, No.4 (2011), 1208-1216
Abstract: Information on the long-term prognosis of nonalcoholic fatty liver disease (NAFLD) is limited. We sought to describe the long-term morbidity and mortality of patients with NAFLD with advanced fibrosis or cirrhosis by prospectively studying 247 such patients from four international centers (in Australia, USA, UK and Italy). Their natural history was then compared with 264 patients with HCV infection who were either naïve or non-responders to treatment. Both cohorts were Child-Pugh class A and had advanced fibrosis (stage 3) or cirrhosis (stage 4) confirmed by liver biopsy at enrollment. In the NAFLD cohort, followed up for a mean of 85.6 months (range, 6-297), there were 48 (19.4%) liver-related complications and 33 (13.4%) deaths or liver transplants. In the HCV cohort, followed up for 74.9 months (mean; range, 6-238), there were 47 (16.7%) liver-related complications and 25 (9.4%) deaths or liver transplants. When adjusting for baseline differences in age and gender, the cumulative incidence of liver-related complications was lower in the NAFLD than the HCV cohort (P = 0.03), including incident hepatocellular cancer (6 versus 18; P = 0.03), but that of cardiovascular events (P = 0.17) and overall mortality (P = 0.6) were similar in both groups. In the NAFLD cohort, platelet count, stage 4 fibrosis, lowered platelet count, and lowered serum cholesterol and alanine aminotrasferase (ALT) levels were associated with liver-related complications; an aspartate aminotransferase/ALT ratio > 1 and older age were associated with overall mortality, and higher serum bilirubin levels and stage 4 fibrosis were associated with liver-related mortality. Conclusions: Patients with NAFLD with advanced fibrosis or cirrhosis have lower rates of liver-related complications and hepatocellular cancer than corresponding patients with HCV infection, but similar overall mortality. Some clinical and laboratory features predict liver-related complications and other outcomes in patients with NAFLD. © 2011 American Association for the Study of Liver Diseases.
ISSN: 15273350
Appears in Collections:Scopus 2011-2015

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