Serum Autotaxin is a Prognostic Indicator of Liver-related Events in Patients with Non-alcoholic Fatty Liver Disease

Abstract

Background: Circulating autotaxin (ATX) levels have been reported to correlate with liver inflammation activity and liver fibrosis severity in patients with non-alcoholic fatty liver disease (NAFLD). The objective of this study was to investigate whether serum ATX could predict liver-related events (LRE) in NAFLD patients. Methods: This retrospective investigation included 309 biopsy-proven NAFLD patients registered at Shinshu University Hospital between 1998 and 2021. All patients were followed for at least 1 year, during which time the prevalence of LRE, including newly developing hepatocellular carcinoma, hepatic encephalopathy, ascites, and esophagogastric varices, was investigated in relation to ATX levels at the time of liver biopsy. Results: During the median follow-up period of 7.0 years, LRE were observed in 20 patients (6.5%). The area under the receiver operating characteristic curve and cut-off value of serum ATX for predicting LRE were 0.81 and 1.227 mg/L, respectively. Patients with serum ATX greater than the cut-off at the time of liver biopsy had a significantly higher cumulative incidence of LRE than those without (18.4% vs. 2.7%, p < 0.00001). Multivariate Cox proportional hazards models for LRE determined fibrosis stage and ATX divided by the upper limit of normal as independently associated factors. Conclusion: Serum ATX may serve as a predictive marker for LRE in patients with NAFLD.