Diabetes mellitus and the progression of non-alcoholic fatty liver disease to decompensated cirrhosis: a retrospective cohort study.

Autor: O'Beirne J; University of the Sunshine Coast, Buderim, QLD.; Sunshine Coast University Hospital, Kawana Waters, QLD., Skoien R; Royal Brisbane and Woman's Hospital Health Service District, Brisbane, QLD., Leggett BA; Royal Brisbane and Woman's Hospital Health Service District, Brisbane, QLD.; The University of Queensland, Brisbane, QLD., Hartel GF; The University of Queensland, Brisbane, QLD.; QIMR Berghofer Medical Research Institute, Brisbane, QLD.; Queensland University of Technology, Brisbane, QLD., Gordon LG; The University of Queensland, Brisbane, QLD.; QIMR Berghofer Medical Research Institute, Brisbane, QLD.; Queensland University of Technology, Brisbane, QLD., Powell EE; The University of Queensland, Brisbane, QLD.; QIMR Berghofer Medical Research Institute, Brisbane, QLD.; Princess Alexandra Hospital Health Service District, Brisbane, QLD., Valery PC; The University of Queensland, Brisbane, QLD.; QIMR Berghofer Medical Research Institute, Brisbane, QLD.
Jazyk: angličtina
Zdroj: The Medical journal of Australia [Med J Aust] 2023 Oct 16; Vol. 219 (8), pp. 358-365. Date of Electronic Publication: 2023 Sep 25.
DOI: 10.5694/mja2.52104
Abstrakt: Objective: To determine the incidence of decompensated cirrhosis and associated risk factors in people hospitalised with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) with or without cirrhosis.
Design: Retrospective cohort study; analysis of linked Queensland Hospital Admitted Patient Data Collection, Queensland Registry of Births, Deaths and Marriages, and Queensland Cancer Register data.
Setting, Participants: Queensland residents aged 20 years or older admitted to Queensland hospitals with NAFLD/NASH during 1 July 2009 - 31 December 2018.
Main Outcome Measures: Progression to decompensated cirrhosis (ascites, hepatic encephalopathy, or oesophageal variceal bleeding).
Results: We included data for 8006 patients in our analysis (10 082 admissions), including 4632 women (58%) and 2514 people with diabetes mellitus (31%); median follow-up time was 4.6 years (interquartile range, 2.7-7.2 years). Three hundred and fifty-one people (4.4%) experienced decompensated cirrhosis during the follow-up period. Of the 6900 people without cirrhosis, 4.5% (95% confidence interval [CI], 3.6-5.7%) experienced decompensated cirrhosis within ten years (mean, 0.5% per year; 95% CI, 0.4-0.6% per year); risk of progression was greater for people aged 70 years or older (v 20-39 years: adjusted hazard ratio [aHR], 4.7; 95% CI, 2.0-11.0) and those who had extrahepatic cancers (aHR, 5.0; 95% CI, 3.0-8.2), history of major cardiovascular events (aHR, 1.9; 95% CI, 1.2-3.1), or diabetes mellitus (aHR, 2.8; 95% CI, 2.0-3.9). Of the 1106 people with cirrhosis, 32.4% (95% CI, 27.2-38.3%) experienced decompensated cirrhosis within ten years (mean, 5.5% per year; 95% CI, 4.8-6.3% per year); risk of progression was greater for those with portal hypertension (aHR, 1.8; 95% CI, 1.3-2.7), extrahepatic cancer (aHR, 1.8; 95% CI, 1.1-2.9), or diabetes mellitus (aHR, 1.5; 95% CI, 1.1-2.0). Compared with people who had neither cirrhosis nor diabetes mellitus, the risk of decompensation was greater for people with cirrhosis (aHR, 10.7; 95% CI, 7.6-15.0) or cirrhosis and diabetes mellitus (aHR, 14.4; 95% CI, 10.1-20.6).
Conclusions: Given the greater risk of progression to cirrhosis decompensation in people with diabetes mellitus, a disorder common in people with NAFLD/NASH, identifying advanced fibrosis and providing appropriate treatment for averting disease progression is vital.
(© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)
Databáze: MEDLINE
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