The clinical and public health significance of non-alcoholic fatty liver disease (NAFLD) is not well established. We investigate the long-term impact of NAFLD on mortality. This analysis utilizes the National Health and Nutrition Examination Survey conducted in 1988–1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the AST-platelet ratio index (APRI), and the FIB-4 score. Out of 11,154 participants, 34.0% had NAFLD - the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS < −1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS > 0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.93–1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (HR 1.69 (95% CI 1.09–2.63) for NFS, 1.85 (1.02–3.37) for APRI, 1.66 (0.98–2.82) for FIB-4) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (HR 3.46 (95% CI 1.91–6.25) for NFS, 2.53 (1.33–4.83) for APRI, 2.68 (1.44–4.99) for FIB-4). Conclusions Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis as determined by non-invasive fibrosis marker panels is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.

Background and Aims Survival of patients with hepatocellular carcinoma (HCC) is determined by the extent of the tumor and the underlying liver function. We aimed to develop a survival model for HCC based on objective parameters including the Model for End stage Liver Disease (MELD) as a gauge of liver dysfunction. Methods This analysis is based on 477 patients with HCC seen at Mayo Clinic Rochester between 1994 and 2008 (derivation cohort) and 904 patients at the Korean National Cancer Center between 2000 and 2003 (validation cohort). Multivariable proportional hazards models and corresponding risk score were created based on baseline demographic, clinical, and tumor characteristics. Internal and external validation of the model was performed. Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores. Results The majority of the patients had viral hepatitis as the underlying liver disease (100% in the derivation cohort and 85% in the validation cohort). The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha-fetoprotein. In cross validation, the coefficients remained largely unchanged between iterations. Observed survival in the validation cohort matched closely with what was predicted by the model. The c-statistic for this model (0.77) was superior to that for BCLC (0.71), CLIP (0.70), or JIS (0.70). The score was able to further classify patient survival within each stage of the BCLC classification. Conclusions A new model to predict survival of HCC patients based on objective parameters provides refined prognostication and supplements the BCLC classification.

No abstract

In this midwestern US community, the incidence of HCC has increased, primarily due to hepatitis C virus. Although there was a demonstrable improvement in the outcome of HCC in community residents over time, the overall prognosis remains poor.