Long term follow-up and liver-related death rate in patients with non-alcoholic and alcoholic related fatty liver disease

Abstract

BackgroundFew studies have compared the prognosis and liver-related mortality in patients with NAFLD (nonalcoholic fatty liver disease) and AFLD (alcoholic fatty liver disease). We aimed to investigate the etiology and liver-related mortality of patients with liver biopsy verified fatty liver disease in a population based setting.MethodsIn this retrospective study, all patients who underwent a liver biopsy 1984–2009 at the National University Hospital of Iceland were identified through a computerized pathological database with the code for fatty liver. Only patients with NAFLD and AFLD were included and medical records reviewed. The patients were linked to the Hospital Discharge Register, the Causes of Death Registry and Centre for Addiction Medicine.ResultsA total of 151 had NAFLD and 94 AFLD with median survival of 24 years and 20 years, respectively (p = NS). A total of 10/151 (7%) patients developed cirrhosis in the NAFLD group and 19/94 (20%) in AFLD group (p = 0.03). The most common cause of death in the NAFLD group was cardiovascular disease (48%). Liver disease was the most common cause of death in the AFLD group (36%), whereas liver-related death occurred in 7% of the NAFLD group. The mean liver-related death rate among the general population during the study period was 0.1% of all deaths. There was a significantly worse survival for patients in the AFLD group compared to the NAFLD group after adjusting for gender, calendar year of diagnosis and age at diagnosis (HR 2.16, p = 0.009). The survival for patients with moderate to severe fibrosis was significantly worse than for patients with mild fibrosis after adjusting for gender, calendar year of diagnosis and age at diagnosis (HR 2.09, p = 0.01).ConclusionsPatients with fatty liver disease showed a markedly higher risk of developing liver-related death compared to the general population. The AFLD group had higher liver-related mortality and had a worse survival than the NAFLD group. Patients with more severe fibrosis at baseline showed a worse survival than patients with none or mild fibrosis at baseline.

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

“…NASH is associated with an increased standardised mortality ratio *According to a priori probability or clinical evaluation. compared with the general population [69] , and liver disease is the third most common cause of death after CVD and cancer. US-diagnosed NAFLD is not associated with increased mortality [70] , presumably because progression to NASH and fibrosis is rare for steatosis alone [49,50] .…”

Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance

“…[4][5][6][7][8][9][10][11][12][13][14][15] Therefore, people with advanced fibrosis require the closest monitoring and have the most to gain from pharmacotherapy slowing or reversing the condition. Of currently available non-invasive tests for identifying NAFLD patients with fibrosis, the enhanced liver fibrosis (ELF) blood test (see box) was found to be most cost effective in identifying patients with advanced liver fibrosis (stages 3 and 4).…”

Вплив Аморфного Нанокремнезему На Показники Мультипараметричного Ультразвукового Дослідження У Хворих На Цукровий Діабет 2-Го Типу З неалкогольною Жировою Хворобою Печінки

“…Метою лікування НАЖХП є насамперед зниження прогресування ураження печінки, стеатозу і смертності від мож-ливих ускладнень [5,6]. Критеріями адекватного лікування НАЖХП у пацієнтів із ЦД 2-го типу є безпека, добра переносимість, відсутність полі-прагмазії і врахування коморбідних станів [1].…”