Predictors of All-Cause Mortality and Liver-Related Mortality in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD)
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Non-alcoholic steatohepatitis (NASH) patients are at increased risk for progression to cirrhosis. The aim of this study was to assess all-cause and liver-specific mortality in a cohort of non-alcoholic fatty liver disease (NAFLD) patients.
Biopsy-proven NAFLD patients with and without NASH from two historic databases were included. Clinico-demographic information from the time of biopsy was available. Mortality data were obtained from National Death Index-Plus and used for estimating overall and cause-specific mortality. The non-parametric Kaplan–Meier method with log-rank test and multivariate analyses with Cox proportional hazard model were used to compare cohorts.
Two hundred eighty-nine NAFLD patients were included (50.3 ± 14.5 years old, 39.4 % male, 78.6 % Caucasian, 46.0 % obese, 26.0 % diabetic, 5.9 % with family history of liver diseases). Of these, 59.2 % had NASH whereas 40.8 % had non-NASH NAFLD. NASH patients were predominantly female, had higher aspartate aminotranserase, alanine aminotransferase and fasting serum glucose. During follow-up (median 150 months, maximum 342 months), patients with NASH had higher probability of mortality from liver-related causes than non-NASH NAFLD patients (p value = 0.0026). In the entire NAFLD cohort, older age [aHR = 1.07 (95 % CI = 1.05–1.10)] and presence of type II diabetes [aHR = 2.09 (1.39–3.14)] were independent predictors of overall mortality. However, in addition to age [aHR = 1.06 (1.02–1.10)] having histologic NASH [aHR = 9.16 (2.10–9.88)] was found to be an independent predictor of liver-related mortality. Additionally, presence of type II diabetes was associated with liver-related mortality [aHR = 2.19 (1.00–4.81)].
This long-term follow-up of NAFLD patients confirms that NASH patients have higher risk of liver-related mortality than non-NASH. Additionally, patients with NAFLD and type II diabetes are at highest risk for overall and liver-related mortality.
KeywordsNon-alcoholic fatty liver disease (NAFLD) Follow-up study Non-alcoholic steatohepatitis (NASH) Mortality
Non-alcoholic fatty liver disease
Body mass index
Center for disease control
National death index
Adjusted hazard ratio
- 95 % CI
95 % Confidence interval
This study has been supported in part by the Liver Disease Outcomes Fund of the Center for Liver Diseases at Inova Fairfax Hospital, Inova Health System, Falls Church, VA.
Conflict of interest
- 6.Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005–2023.PubMedCrossRefGoogle Scholar
- 17.Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43:617–49. doi: 10.3109/07853890.2010.518623.
- 22.World Health Organization. ICD 10: International Statistical Classification of Diseases and Related Health Problems. Arlington, VA: American Psychiatric Publishing, Inc.; 1992.Google Scholar
- 28.Younossi ZM, Otgonsuren M, Venkatesan C, Mishra A. In patients with non-alcoholic fatty liver disease (NAFLD), metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not. Metabolism. 2013;62:352–360. doi: 10.1016/j.metabol.2012.08.005.
- 33.Stepanova M, Younossi ZM. Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population. Clin Gastroenterol Hepatol. 2012;10:646–650.Google Scholar
- 34.Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: final data for 2007. Natl Vital Stat Rep. 2010;58:1–136.Google Scholar
- 36.Younossi ZM, Venkatesan C. A 2012 clinical update for internists in adult nonalcoholic fatty liver disease. Panminerva Med. 2012;54:29–37. Review.Google Scholar
- 38.Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9:524–530.e1; quiz e60.Google Scholar