NAFLD Study Findings

USA: Fibrosis stages F3 and F4 are associated with increased risks of liver-related complications and death in a prospective study involving patients with nonalcoholic fatty liver disease (NAFLD). The study was published in the New England Journal of Medicine on October 21, 2021.

According to the study, liver disease is usually associated with alcoholism or hepatitis, but obesity and diabetes are becoming an even more dire threat for potentially fatal liver damage.

There is no clarity on the prognoses with respect to mortality and hepatic and nonhepatic outcomes across the histologic spectrum of NAFLD. To clarify the same, Arun J. Sanyal and colleagues prospectively followed a multicenter patient population that included the full histologic spectrum of NAFLD. The incidences of death and other outcomes were compared across baseline histologic characteristics.

The study included a total of 1773 adults with NAFLD who were followed for a median of 4 years.

Key Findings

• All-cause mortality increased with increasing fibrosis stages (0.32 deaths per 100 person-years for stage F0 to F2 [no, mild, or moderate fibrosis], 0.89 deaths per 100 person-years for stage F3 [bridging fibrosis], and 1.76 deaths per 100 person-years for stage F4 [cirrhosis]).
• The incidence of liver-related complications per 100 person-years increased with fibrosis stage (F0 to F2 vs. F3 vs. F4) as follows:
  • Variceal hemorrhage (0.00 vs. 0.06 vs. 0.70)
  • Ascites (0.04 vs. 0.52 vs. 1.20)
  • Encephalopathy (0.02 vs. 0.75 vs. 2.39)
  • Hepatocellular cancer (0.04 vs. 0.34 vs. 0.14)
• As compared with patients with stage F0 to F2 fibrosis, patients with stage F4 fibrosis also had a higher incidence of type 2 diabetes (7.53 vs. 4.45 events per 100 person-years) and a decrease of more than 40% in the estimated glomerular filtration rate (2.98 vs. 0.97 events per 100 person-years).
• The incidence of cardiac events and nonhepatic cancers were similar across fibrosis stages.
• After adjustment for age, sex, race, diabetes status, and baseline histologic severity, the incidence of any hepatic decompensation event (variceal hemorrhage, ascites, or encephalopathy) was associated with increased all-cause mortality (adjusted hazard ratio, 6.8).

The researchers concluded, "in this prospective study involving patients with NAFLD, fibrosis stages F3 and F4 were associated with increased risks of liver-related complications and death."

Reference

The study titled, "Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease," is published in the New England Journal of Medicine.

DOI: https://www.nejm.org/doi/10.1056/NEJMoa2029349