Long-Term Follow-Up of Patients With Nonalcoholic Fatty Liver

published online 11 November 2008.

Background & Aims

Nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of conditions ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) convincingly. NASH is the only subtype of NAFLD that has been shown to progress relatively, although these findings were reported from studies with short follow-up periods. We assessed the long-term outcomes of a NAFLD cohort.

Methods

Patients with NAFLD established by biopsy were identified in databases and categorized as NASH or non-NASH. Mortality data and causes of death were obtained from National Death Index Plus. The nonparametric Kaplan–Meier method with log-rank test and multivariate analyses with a Cox proportional hazard model were used to compare different NAFLD subtypes and to identify independent predictors of overall and liver-related mortality.

Results

Of 173 NAFLD patients (age at biopsy, 50.2 ± 14.5 y; 39.9% male; 80.8% Caucasian; 28.9% with type II diabetes), 72 (41.6%) had NASH and 101 (58.4%) had non-NASH NAFLD. Over the follow-up period, the most common causes of death were coronary artery disease, malignancy, and liver-related death. Although overall mortality did not differ between the NAFLD subtypes, liver-related mortality was higher in patients with NASH (P < .05). Independent predictors of liver-related mortality included histologic NASH, type II diabetes, older age at biopsy, lower albumin levels, and increased levels of alkaline phosphatase (P < .05).

Conclusions

This long-term follow-up evaluation of NAFLD patients confirms that NASH patients have increased liver-related mortality compared with non-NASH patients. In addition, patients with NAFLD and type II diabetes are especially at risk for liver-related mortality.

Abbreviations used in this paper: ALT, alanine aminotransferase, AST, aspartate aminotransferase, BMI, body mass index, CCF, Cleveland Clinic Foundation, CLD, Center for Liver Diseases, ICD, International Classification of Diseases, NAFLD, nonalcoholic fatty liver disease, NASH, nonalcoholic steatohepatitis, NDI Plus, National Death Index Plus

⁎ Center for Liver Diseases, Inova Health System, Annandale, Virginia

‡ Department of Gastroenterology and Hepatology, the Cleveland Clinic Foundation, Cleveland, Ohio

Address requests for reprints to: Zobair M. Younossi, MD, MPH, Center for Liver Diseases at Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, Virginia 22042. fax: (703) 208-6655

The authors disclose no conflicts.

PII: S1542-3565(08)01119-1

doi:10.1016/j.cgh.2008.11.005

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