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Fibrosis score linked to increased overall, liver disease mortality

Data from a recently published study revealed a significant association between liver fibrosis scores and increased rates of liver disease mortality and overall mortality.

“In a previous paper using the third National Health and Nutrition Examination Survey (NHANES III) population with mortality follow-up through 2006, fibrosis predicted by [nonalcoholic fatty liver disease score (NFS), aminotransferase-to-platelet ratio (APRI) or stage 4 score] was independently associated with increased mortality, primarily from cardiovascular disease, among persons with suspected NAFLD,” Aynur Unalp-Arida, MD, PhD, and Constance E. Ruhl, MD, PhD, wrote. “Mortality ascertainment is now complete for NHANES III through 2011, providing up to 23 years of follow-up.”

NHANES III, conducted by the CDC from 1988 to 1994, includes passive follow-up data on mortality for 23,258 adult individuals up to Dec. 31, 2011. This study excluded patients with hepatitis B and hepatitis C, those missing viral hepatitis serology or fibrosis scores and those with unclear data related to cause of death. The study comprised 14,841 patients analyzed for APRI and fibrosis stage 4 scores, 14,741 analyzed for NFS and 11,589 analyzed for Forns score.

There were 4,835 deaths at 23 years of follow-up. Specific causes of death included cardiovascular disease (n = 1,993), neoplasm (n = 1,216), diabetes (n = 593) and liver disease (n = 151).

Mortality rates related to liver disease were significantly higher in patients with intermediate to high APRI (HR = 9.44; 95% CI, 5.02-17.73), intermediate (HR = 3.15; 95% CI, 1.33-7.44) or high fibrosis stage 4 score (HR = 25.14; 95% CI, 8.38-75.4), high NFS (HR = 6.52; 95% CI, 2.3-18.5) and intermediate (HR = 3.58; 95% CI, 1.78-7.18) or high Forns score (HR = 63.13; 95% CI, 22.16-179.78).

Similarly, overall mortality rates were higher in patients with intermediate to high APRI (HR = 1.39; 95% CI, 1.08-1.79), intermediate (HR = 1.11; 95% CI, 1.01-1.22) or high fibrosis stage 4 score (HR = 1.56; 95% CI, 1.29-1.88), high NFS (HR = 1.39; 95% CI, 1.2-1.6) and high Forns score (HR = 1.57; 95% CI, 1.19-2.08).

Cardiovascular disease mortality rates were higher among those with high fibrosis stage 4 score (HR = 1.56; 95% CI, 1.17-2.08). Mortality rates related to neoplasms were higher in those with intermediate to high APRI (HR = 1.67; 95% CI, 1.13-2.45). Diabetes mortality rates were higher in those with intermediate (HR = 1.78; 95% CI, 1.23-2.58) or high Forns score (HR = 2.65; 95% CI, 1.28-5.48).

“In the United States population, intermediate to high liver fibrosis scores were associated with increased liver disease mortality,” the researchers concluded. “A 2012 American Gastroenterological Association practice guideline on the diagnosis and management of NAFLD recommended the clinical use of the NFS for identifying NAFLD patients with higher likelihood of having bridging fibrosis and/or cirrhosis. Our study provides support for the use of fibrosis scores, including the NFS for identifying persons at high risk for advanced fibrosis.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.