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Fibrosis severity determines cause-specific mortality in NAFLD

New data showed that in nonalcoholic fatty liver disease, patients with cirrhosis were more likely to experience liver-related events while those with bridging fibrosis were more likely to experience non-hepatic cancers and vascular events.

“Taken as a whole, previous and current findings highlight the importance of underlying fibrosis stage in determining clinical outcomes and cause-specific mortality,” Eduardo Vilar-Gomez, MD, PhD, from the Indiana University School of Medicine, and colleagues wrote.

To investigate the long-term outcomes among patients with NAFLD and varying stages of fibrosis, Vilar-Gomez and colleagues accessed patient data from the NAFLD progression consortium (NPC), an international initiative with referral centers in Europe, Asia, Australia and America.

The study comprised 159 patients with bridging fibrosis and 299 patients with cirrhosis. During a mean follow-up of 5.5 years, 74 patients died or underwent liver transplantation. Liver-related events were the most common cause of death (n = 31) compared with other events (n = 6).

Patients with cirrhosis were more likely to develop hepatic decompensation (44% vs. 6%; P < .01) and hepatocellular carcinoma (17% vs. 2.3%; P < .01) than patients with bridging fibrosis, especially among those with Child-Pugh class A6 compared with those with class A5 (P < .01).

In contrast, the researchers found that patients with fibrosis stage 3 were significantly more likely to develop any vascular events compared with patients with stage 4 (7% vs. 2%; P < .01). After excluding skin cancer, patients with fibrosis stage 3 were more likely to develop non-hepatic malignant neoplasia than those with stage 4, but the difference was not significant.

“While patients with bridging fibrosis have lower probabilities of liver-related outcomes within the first 10 years of follow-up, the greater likelihood of vascular events and non-hepatic malignancies suggests surveillance and prevention strategies for these outcomes should be prioritized as part of their management,” the researchers concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.