February 06, 2020
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Fibrosis linked with mortality, liver-related morbidity risk in patients with NAFLD

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Biopsy-confirmed fibrosis was associated with risk for mortality and liver-related morbidity in patients with NAFLD, regardless of confounding factors and in patients with NASH, according to study results.

Rod S. Taylor, MSc, PHD, chair of population health research at the University of Glasgow, and colleagues wrote that it is widely accepted that liver fibrosis develops as a result of liver injury secondary to steatohepatitis in patients with NAFLD.

“Given that disease activity in NASH may fluctuate over time and liver biopsy may be subject to sampling variability, some patients with NASH may be miscategorized as not having NASH,” they wrote. “Moreover, the fibrosis progression rate and the proportion of individuals with NAFLD having fibrosis progression was similar in a long-term study in with paired patient liver biopsies according to whether or not they had NASH at baseline.”

Researchers conducted a meta-analysis to assess the value of fibrosis stage in patients with NAFLD and a subgroup of patients with NASH. They searched the literature for prospective and retrospective cohort studies of liver-related medical events and outcomes in adults with NAFLD or NASH. Using biopsy data, they collected information on mortality and morbidity by stage of fibrosis, using no fibrosis as a reference population.

Investigators identified 13 studies comprising 4,428 patients with NAFLD that fit their criteria. Of those patients, 2,875 had NASH.

Compared with no fibrosis, stage four fibrosis was associated with risk for all-cause mortality (RR = 3.42; 95% CI, 2.63–4.46), liver-related mortality (RR = 11.13; 95% CI, 4.15–29.84), liver transplantation (RR = 5.42; 95% CI, 1.05–27.89) and liver-related events (RR = 12.75; 95% CI, 6.85–23.85).

After adjusting for confounders, like age or sex in the subgroup of patients with NASH, Taylor and colleagues found that the magnitude of relative risk did not change.

“Increasing fibrosis stage being associated with a five to 12-fold increase in the relative risk of liver-related events. Further evidence from well-reported studies is needed in order to clarify the impact of fibrosis stage on patient well-being, and to confirm change in biopsy-confirmed fibrosis as a valid surrogate endpoint in the context of randomized controlled trials of treatments for NAFLD and NASH.” – by Alex Young

Disclosure: Taylor reports receiving funding from Gilead. Please see the full guidelines for all other authors’ relevant financial disclosures.