Publication: Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease
Issued Date
2015-08-01
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ISSN
15280012
00165085
00165085
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2-s2.0-84938057875
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Mahidol University
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SCOPUS
Bibliographic Citation
Gastroenterology. Vol.149, No.2 (2015), 389-397.e10
Suggested Citation
Paul Angulo, David E. Kleiner, Sanne Dam-Larsen, Leon A. Adams, Einar S. Bjornsson, Phunchai Charatcharoenwitthaya, Peter R. Mills, Jill C. Keach, Heather D. Lafferty, Alisha Stahler, Svanhildur Haflidadottir, Flemming Bendtsen Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. Vol.149, No.2 (2015), 389-397.e10. doi:10.1053/j.gastro.2015.04.043 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/36369
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Title
Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease
Other Contributor(s)
University of Kentucky Chandler Medical Center
National Cancer Institute
Koege University Hospital
University of Western Australia Faculty of Medicine and Dentistry
University of Iceland
Mahidol University
Gartnavel General Hospital
Mayo Clinic
Rikshospitalet-Radiumhospitalet HF
Kobenhavns Universitet
National Cancer Institute
Koege University Hospital
University of Western Australia Faculty of Medicine and Dentistry
University of Iceland
Mahidol University
Gartnavel General Hospital
Mayo Clinic
Rikshospitalet-Radiumhospitalet HF
Kobenhavns Universitet
Abstract
© 2015 by the AGA Institute. Background & Aims Histologic analysis of liver biopsy specimens allows for grading and staging of nonalcoholic fatty liver disease (NAFLD). We performed a longitudinal study to investigate the long-term prognostic relevance of histologic features for patients with NAFLD. Methods We performed a retrospective analysis of 619 patients diagnosed with NAFLD from 1975 through 2005 at medical centers in the United States, Europe, and Thailand. Patients underwent laboratory and biopsy analyses, and were examined every 3-12 months after their diagnosis. Outcomes analyzed were overall mortality, liver transplantation, and liver-related events. Cumulative outcomes were compared by log-rank analysis. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (HRs). Time at risk was determined from the date of liver biopsy to the date of outcome or last follow-up examination. Results Over a median follow-up period of 12.6 years (range, 0.3-35.1 y), 193 of the patients (33.2%) died or underwent liver transplantation. Features of liver biopsies significantly associated with death or liver transplantation included fibrosis stage 1 (HR, 1.88; 95% confidence interval [CI], 1.28-2.77), stage 2 (HR, 2.89; 95% CI, 1.93-4.33), stage 3 (HR, 3.76; 95% CI, 2.40-5.89), and stage 4 (HR, 10.9; 95% CI, 6.06-19.62) compared with stage 0, as well as age (HR, 1.07; 95% CI, 1.05-1.08), diabetes (HR, 1.61; 95% CI, 1.13-2.30), current smoking (HR, 2.62; 95% CI, 1.67-4.10), and statin use (HR, 0.32; 95% CI, 0.14-0.70). Twenty-six patients (4.2%) developed liver-related events; fibrosis stage 3 (HR, 14.2; 95% CI, 3.38-59.68) and stage 4 (HR, 51.5; 95% CI, 9.87-269.2) compared with stage 0, were associated significantly with the events. Patients with fibrosis, regardless of steatohepatitis or NAFLD activity score, had shorter survival times than patients without fibrosis. Conclusions In a longitudinal study of patients with NAFLD, fibrosis stage, but no other histologic features of steatohepatitis, were associated independently with long-term overall mortality, liver transplantation, and liver-related events.