Premium
The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study
Author(s) -
Bhala Neeraj,
Angulo Paul,
van der Poorten David,
Lee Eric,
Hui Jason M.,
Saracco Giorgio,
Adams Leon A.,
Charatcharoenwitthaya Phunchai,
Topping Joanne H.,
Bugianesi Elisabetta,
Day Christopher P.,
George Jacob
Publication year - 2011
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.24491
Subject(s) - medicine , cirrhosis , gastroenterology , nonalcoholic fatty liver disease , cohort , liver disease , cumulative incidence , liver biopsy , incidence (geometry) , cohort study , fatty liver , biopsy , disease , physics , optics
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 by prospectively studying 247 such patients from four international centers (in Australia, USA, UK and Italy). Their natural history was then compared with 264 patients with HCV infection who were either naïve or non‐responders to treatment. Both cohorts were Child‐Pugh class A and had advanced fibrosis (stage 3) or cirrhosis (stage 4) confirmed by liver biopsy at enrollment. In the NAFLD cohort, followed up for a mean of 85.6 months (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 versus 18; P = 0.03), but that of cardiovascular events ( P = 0.17) and overall mortality ( P = 0.6) were similar in both groups. In the NAFLD cohort, platelet count, stage 4 fibrosis, lowered platelet count, and lowered serum cholesterol and alanine aminotrasferase (ALT) levels were associated with liver‐related complications; an aspartate aminotransferase/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 liver‐related complications and other outcomes in patients with NAFLD. (H EPATOLOGY 2011;54:1208–1216)