The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study

Abstract

Information on the long-term prognosis of nonalcoholic fatty liver disease (NAFLD) is limited. We sought to describe the long-term morbidity and mortality of patients with NAFLD with advanced fibrosis or cirrhosis. We conducted this prospective cohort study including 247 patients with NAFLD and 264 patients with HCV infection that were either naïve or non-responders to treatment. Both cohorts were Child-Pugh class A and had advanced (stage 3) fibrosis or cirrhosis (stage 4) confirmed by liver biopsy at enrolment. In the NAFLD cohort, followed-up for 85.6 months mean (range 6-297), there were 48 (19.4%) liver-related complications and 33 (13.4%) deaths or liver transplants. In the HCV cohort, followed-up for 74.9 months mean (range 6-238), there were 47 (16.7%) liver-related complications and 25 (9.4%) deaths or liver transplants. When adjusting for baseline differences in age and gender, the cumulative incidence of liver-related complications was lower in the NAFLD than the HCV cohort (p=0.03), including incident hepatocellular cancer (6 vs 18; p=0.03), but that of cardiovascular events (p=0.17) and overall mortality (p=0.6) was similar in both groups. In the NAFLD cohort, platelet count, stage 4 fibrosis, and serum levels of cholesterol and ALT were associated with liver-related complications; an AST/ALT ratio >1 and older age were associated with overall mortality; and higher serum bilirubin levels and stage 4 fibrosis were associated with liver-related mortality. Conclusions Patients with NAFLD with advanced fibrosis or cirrhosis have lower rates of liver-related complications and hepatocellular cancer than corresponding patients with HCV infection, but similar overall mortality. Some clinical and laboratory features predict outcomes in patients with NAFLD.

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…[48][49][50][51][52][53] Several studies investigated the natural history of NASH cirrhosis in comparison to patients with hepatitis C cirrhosis. [54][55][56][57] One large prospective US-based study 55 observed a lower rate of decompensation and mortality in patients with NASH cirrhosis as compared to patients with hepatitis C cirrhosis. However, a more recent international study 56 of 247 NAFLD patients with advanced fibrosis and cirrhosis followed over a mean duration of 85.6 6 54.5 months showed an overall 10-year survival of 81.5% that was not different from matched patients with hepatitis C cirrhosis.…”

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

“…Experts reviewed the data from the AARC, and the etiologic profile of cirrhosis in ACLF was found to be similar to the etiology of cirrhosis in general in the respective countries [26,46,47]. With the rising incidence of obesity and NAFLD, proportion of burnt-out NASH presenting as cryptogenic cirrhosis is also increasing [48][49][50].…”

Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups

“…167,168 This finding may be of potential significance in differentiating simple steatosis from NASH 167 and suggests that most hyperlipidemic patients with increased non-HDL cholesterol levels are potential candidates to liver biopsy, given that they are more likely to develop NASH. Hepatic biosynthetic failure occurring in those developing cirrhosis will blunt the severity of the initial dyslipidemia [169][170][171] mirroring the disappearance of hepatic steatosis associated with the development of NASH-cirrhosis.…”