Risk factors for biopsy‐proven advanced non‐alcoholic fatty liver disease in the Veterans Health Administration

Patel, Yuval A.; Gifford, Elizabeth J.; Glass, Lisa; McNeil, Rebecca B.; Turner, Marsha J.; Han, Byungjoo; Provenzale, Dawn; Choi, Steven S; Moylan, Cynthia A.; Hunt, Christine M.

doi:10.1111/apt.14411

Cited by 37 publications

(29 citation statements)

References 49 publications

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“…These surrogate scores combine blood surrogates of hepatic synthetic capacities (ie, albumin), liver cell injury and remodelling (ie, AST), and portal hypertension (ie, thrombocytes) with clinical risk factors, inducing age and the presence of diabetes. In the current cohort, albumin, AST, platelets, HbA1c, or the presence of diabetes and age were significantly different between patients with early vs advanced fibrosis, confirming the diagnostic plausibility of these commonly used surrogates in a German cohort . However, the performance of NFS, APRI, and Fib‐4 were only fair to low in this cohort when excluding cirrhotic patients.…”

Section: Discussionsupporting

confidence: 66%

“…Also, in clinical practice, liver function tests are the most likely cause of were significantly different between patients with early vs advanced fibrosis, confirming the diagnostic plausibility of these commonly used surrogates in a German cohort. 30,31 However, the performance of NFS, APRI, and Fib-4 were only fair to low in this cohort when excluding cirrhotic patients. This highlights the urgent need for better, noninvasive risk stratification algorithms to reliable identify patients with need for liver biopsy and potential treatment.…”

Section: Discussionmentioning

confidence: 75%

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Predictors of advanced fibrosis in non‐cirrhotic non‐alcoholic fatty liver disease in Germany

Labenz

Huber

Kalliga

et al. 2018

Aliment Pharmacol Ther

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Summary Background Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non‐alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non‐cirrhotic NAFLD is difficult to identify and data from Germany are lacking. Aim To identify clinical factors associated with advanced, non‐cirrhotic fibrosis. Methods Patients were recruited in the prospectively enrolling European NAFLD Registry. Clinical characteristics and the performance of non‐invasive surrogate scores compared with vibration‐controlled transient elastography are reported. Results Two hundred and sixty‐one patients with non‐cirrhotic NAFLD on liver biopsy (mean age 51 years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50 years, P < 0.01), had a higher body mass index (32.3 vs 30.5, P < 0.05), and more frequent arterial hypertension (78% vs 50%, P = 0.001) and type 2 diabetes (61% vs 24.1%, P < 0.001). On multivariate logistic regression, diabetes (OR = 4.68, 95% CI 2.17‐10.10) and hypertension (OR = 2.91, 95% CI 1.12‐7.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an AUROC of 0.81 (95% CI 0.72‐0.91). The performance of NAFLD fibrosis score, Fibrosis‐4, and AST to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively. Conclusions The prevalence of metabolic comorbidities in a German population with non‐cirrhotic biopsy‐proven NAFLD is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood‐based non‐invasive surrogate scores in ruling out advanced fibrosis.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 75%

Predictors of advanced fibrosis in non‐cirrhotic non‐alcoholic fatty liver disease in Germany

Labenz

Huber

Kalliga

et al. 2018

Aliment Pharmacol Ther

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“…Of note, 68% of women and 56% of men with T2DM in the VHA are obese . The study also highlights the need to educate healthcare providers about NAFLD. Even for a study between 2005 and 2015, lifestyle or pharmacological interventions were unacceptably low.…”

mentioning

confidence: 85%

“…In a recent issue, Patel makes an even stronger case for action. They examine risk factors for advanced NASH in 399 patients identified with a liver biopsy between 2005 and 2015.…”

mentioning

confidence: 99%

Editorial: diabetes, obesity and clinical inertia—the recipe for advanced NASH

Leey

Cusi

2018

Aliment Pharmacol Ther

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“…Diabetes is considered as the risk factor for HCC, especially in males (Hagstrom et al, ; Simon et al, ). In randomly selected cases from the Veterans Health Administration databases (2005–2015), the incidences of NAFLD, fibrosis, and HCC among diabetic patients were significantly higher than those without diabetes (Patel et al, ). Besides, hyperlipidemia is also a common metabolic risk factor for NAFLD.…”

Section: Epidemiology Of Nafld‐related Hccmentioning

confidence: 99%

Role of MicroRNAs in the Development of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Zhang

Wang

et al. 2018

The Anatomical Record

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Hepatocellular carcinoma (HCC) is a prevalent liver malignancy that can be developed from nonalcoholic fatty liver disease (NAFLD). Numerous pathophysiological alterations, including insulin resistance, specific cytokine release, oxidative stress, and mitochondrial damage, are involved in the transition of NAFLD to cirrhosis and HCC. MicroRNAs, as post-transcriptional modulators, play a critical role in the pathogenesis of NAFLD-related HCC by regulating lipid metabolism, glucose homeostasis, cell proliferation, apoptosis, migration, and differentiation. This review summarizes the current progress of microRNAs in the risk and prognosis of NAFLD-related HCC.

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Risk factors for biopsy‐proven advanced non‐alcoholic fatty liver disease in the Veterans Health Administration

Cited by 37 publications

References 49 publications

Predictors of advanced fibrosis in non‐cirrhotic non‐alcoholic fatty liver disease in Germany

Predictors of advanced fibrosis in non‐cirrhotic non‐alcoholic fatty liver disease in Germany

Editorial: diabetes, obesity and clinical inertia—the recipe for advanced NASH

Role of MicroRNAs in the Development of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

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