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A tool to predict progression of non‐alcoholic fatty liver disease in severely obese patients
Author(s) -
Bauvin Pierre,
Delacôte Claire,
Lassailly Guillaume,
Ntandja Wandji Line Carolle,
Gnemmi Viviane,
Dautrecque Flavien,
Louvet Alexandre,
Caiazzo Robert,
Raverdy Violeta,
Leteurtre Emmanuelle,
Pattou François,
DeufficBurban Sylvie,
Mathurin Philippe
Publication year - 2021
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14650
Subject(s) - medicine , fatty liver , steatohepatitis , overweight , steatosis , cirrhosis , disease , body mass index , population , diabetes mellitus , fibrosis , endocrinology , environmental health
Background & Aims Severely obese patients are a growing population at risk of non‐alcoholic fatty liver disease (NAFLD). Considering the increasing burden, a predictive tool of NAFLD progression would be of interest. Our objective was to provide a tool allowing general practitioners to identify and refer the patients most at risk, and specialists to estimate disease progression and adapt the therapeutic strategy. Methods This predictive tool is based on a Markov model simulating steatosis, fibrosis and non‐alcoholic steatohepatitis (NASH) evolution. This model was developped from data of 1801 severely obese, bariatric surgery candidates, with histological assessment, integrating duration of exposure to risk factors. It is then able to predict current disease severity in the absence of assessment, and future cirrhosis risk based on current stage. Results The model quantifies the impact of sex, body‐mass index at 20, diabetes, age of overweight onset, on progression. For example, for 40‐year‐old severely obese patients seen by the general practitioners: (a) non‐diabetic woman overweight at 20, and (b) diabetic man overweight at 10, without disease assessment, the model predicts their current risk to have NASH or F3‐F4: for (a) 5.7% and 0.6%, for (b) 16.1% and 10.0% respectively. If those patients have been diagnosed F2 by the specialist, the model predicts the 5‐year cirrhosis risk: 1.8% in the absence of NASH and 6.0% in its presence for (a), 10.3% and 26.7% respectively, for (b). Conclusions This model provides a decision‐making tool to predict the risk of liver disease that could help manage severely obese patients.