Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study

Autor: Anthony W.H. Chan, Mayada Metwally, Mohammed Eslam, Luis Calzadilla-Bertot, María Alvarez-Quiñones Sanz, Naga Chalasani, Duncan McLeod, Antonio Felix Conde-Martin, Bastiaan De Boer, Rocio Aller-de la Fuente, Jacob George, Licet Gonzalez-Fabian, Eduardo Vilar-Gomez, Manuel Romero-Gómez, Marlen Castellanos, Vincent Wai-Sun Wong, Leon A. Adams
Rok vydání: 2018
Předmět:
Liver Cirrhosis
Male
0301 basic medicine
medicine.medical_specialty
Carcinoma
Hepatocellular
Cirrhosis
Biopsy
medicine.medical_treatment
Nonalcoholic Steatohepatitis
Liver transplantation
Severity of Illness Index
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Model for End-Stage Liver Disease
Non-alcoholic Fatty Liver Disease
Internal medicine
Nonalcoholic fatty liver disease
Humans
Medicine
Decompensation
Cumulative incidence
Competing Risk Analysis
Aged
Hepatology
medicine.diagnostic_test
business.industry
Incidence
Liver Neoplasms
Middle Aged
Gastroesophageal Varices
medicine.disease
Liver Transplantation
Transplantation
Editorial
030104 developmental biology
Liver
Cryptogenic Cirrhosis
Cardiovascular Diseases
Liver biopsy
Disease Progression
Female
030211 gastroenterology & hepatology
business
Follow-Up Studies
Zdroj: Gastroenterology. 155:443-457.e17
ISSN: 0016-5085
DOI: 10.1053/j.gastro.2018.04.034
Popis: Little is known about the natural course of nonalcoholic fatty liver disease (NAFLD) with advanced fibrosis. We describe long-term outcomes and evaluate the effects of clinical and histologic parameters on disease progression in patients with advanced NAFLD.We conducted a multi-national study of 458 patients with biopsy-confirmed NAFLD with bridging fibrosis (F3, n = 159) or compensated cirrhosis (222 patients with Child-Turcotte-Pugh scores of A5 and 77 patients with scores of A6), evaluated from April 1995 through November 2013 and followed until December 2016, death, or liver transplantation at hepatology centers in Spain, Australia, Hong Kong, and Cuba. Biopsies were re-evaluated and scored; demographic, clinical, laboratory, and pathology data for each patient were collected from the time of liver biopsy collection. Cox proportional and competing risk models were used to estimate rates of transplantation-free survival and major clinical events and to identify factors associated with outcomes.During a mean follow-up time of 5.5 years (range, 2.7-8.2 years), 37 patients died, 37 received liver transplants, 88 had initial hepatic decompensation events, 41 developed hepatocellular carcinoma, 14 had vascular events, and 30 developed nonhepatic cancers. A higher proportion of patients with F3 fibrosis survived transplantation-free for 10 years (94%; 95% confidence interval [CI], 86%-99%) than of patients with cirrhosis and Child-Turcotte-Pugh A5 (74%; 95% CI, 61%-89%) or Child-Turcotte-Pugh A6 (17%; 95% CI, 6%-29%). Patients with cirrhosis were more likely than patients with F3 fibrosis to have hepatic decompensation (44%; 95% CI, 32%-60% vs 6%, 95% CI, 2%-13%) or hepatocellular carcinoma (17%; 95% CI, 8%-31% vs 2.3%, 95% CI, 1%-12%). The cumulative incidence of vascular events was higher in patients with F3 fibrosis (7%; 95% CI, 3%-18%) than cirrhosis (2%; 95% CI, 0%-6%). The cumulative incidence of nonhepatic malignancies was higher in patients with F3 fibrosis (14%; 95% CI, 7%-23%) than cirrhosis (6%; 95% CI, 2%-15%). Death or transplantation, decompensation, and hepatocellular carcinoma were independently associated with baseline cirrhosis and mild (33%) steatosis, whereas moderate alcohol consumption was associated with these outcomes only in patients with cirrhosis.Patients with NAFLD cirrhosis have predominantly liver-related events, whereas those with bridging fibrosis have predominantly nonhepatic cancers and vascular events.
Databáze: OpenAIRE
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