Abstract
Aim
Non-alcoholic steatohepatitis (NASH) patients are at increased risk for progression to cirrhosis. The aim of this study was to assess all-cause and liver-specific mortality in a cohort of non-alcoholic fatty liver disease (NAFLD) patients.
Methods
Biopsy-proven NAFLD patients with and without NASH from two historic databases were included. Clinico-demographic information from the time of biopsy was available. Mortality data were obtained from National Death Index-Plus and used for estimating overall and cause-specific mortality. The non-parametric Kaplan–Meier method with log-rank test and multivariate analyses with Cox proportional hazard model were used to compare cohorts.
Results
Two hundred eighty-nine NAFLD patients were included (50.3 ± 14.5 years old, 39.4 % male, 78.6 % Caucasian, 46.0 % obese, 26.0 % diabetic, 5.9 % with family history of liver diseases). Of these, 59.2 % had NASH whereas 40.8 % had non-NASH NAFLD. NASH patients were predominantly female, had higher aspartate aminotranserase, alanine aminotransferase and fasting serum glucose. During follow-up (median 150 months, maximum 342 months), patients with NASH had higher probability of mortality from liver-related causes than non-NASH NAFLD patients (p value = 0.0026). In the entire NAFLD cohort, older age [aHR = 1.07 (95 % CI = 1.05–1.10)] and presence of type II diabetes [aHR = 2.09 (1.39–3.14)] were independent predictors of overall mortality. However, in addition to age [aHR = 1.06 (1.02–1.10)] having histologic NASH [aHR = 9.16 (2.10–9.88)] was found to be an independent predictor of liver-related mortality. Additionally, presence of type II diabetes was associated with liver-related mortality [aHR = 2.19 (1.00–4.81)].
Conclusions
This long-term follow-up of NAFLD patients confirms that NASH patients have higher risk of liver-related mortality than non-NASH. Additionally, patients with NAFLD and type II diabetes are at highest risk for overall and liver-related mortality.
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Abbreviations
- NAFLD:
-
Non-alcoholic fatty liver disease
- NASH:
-
Non-alcoholic steatohepatitis
- BMI:
-
Body mass index
- CDC:
-
Center for disease control
- NDI:
-
National death index
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotranserase
- LRM:
-
Liver-related mortality
- aHR:
-
Adjusted hazard ratio
- 95 % CI:
-
95 % Confidence interval
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Acknowledgments
This study has been supported in part by the Liver Disease Outcomes Fund of the Center for Liver Diseases at Inova Fairfax Hospital, Inova Health System, Falls Church, VA.
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Stepanova, M., Rafiq, N., Makhlouf, H. et al. Predictors of All-Cause Mortality and Liver-Related Mortality in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD). Dig Dis Sci 58, 3017–3023 (2013). https://doi.org/10.1007/s10620-013-2743-5
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DOI: https://doi.org/10.1007/s10620-013-2743-5