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Fatty liver progresses quickly, increasing mortality risk
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VIENNA — Patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis showed progression to advanced liver disease within 10 years of diagnosis as well as increased risk for mortality, according to new data presented during the International Liver Congress 2019.
“NAFLD is not a benign condition,” Jerome Boursier, MD, PhD, from Angers University Hospital in Angers, France, said during a press conference. “We need to develop strategies for early identification of those patients at risk of liver-related complications and we need new effective treatments to avoid evolution to late stage of disease.”
French study
In the French study presented by Boursier, investigators identified 125,052 patients with NAFLD or NASH in the French National Database on hospital care from 2009 to 2015. Of these patients, 1.2% had compensated cirrhosis, 6.3% had decompensated cirrhosis and 0.9% had hepatocellular carcinoma.
“A majority of patients — 84% of the cirrhotic patients — were diagnosed with cirrhosis at the time of their first liver-related event,” Boursier said. “The diagnosis is too late.”
Boursier said some patients (5.6%) showed rapid progression to advanced disease within the 7 years of follow up. Of the patients with compensated cirrhosis, 27.5% progressed to decompensation.
“Cirrhosis is really a turning point in the natural history of the disease,” Boursier said.
At 1-year follow-up, 2.2% of patients with NAFLD or NASH died, specifically 4.9% of those with compensated cirrhosis, 19.7% of those with decompensated cirrhosis and 29.1% of those with HCC. At 7 years, those numbers moved to 7.9% of all patients with NALFD or NASH, 18% of patients with compensated cirrhosis and 34.9% of those with decompensated cirrhosis and 48.8% of those with HCC.
Zobair Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital, Virginia, said studies like these are important because they represent real-world scenarios for patients with NAFLD.
“Most of the other studies ... came from tertiary care centers ... and there’s always a bias. This study comes from real-world practice and it doesn’t have that bias,” Younossi said. “It is consistent with data that now we are seeing from death data in the United States and NHANES data from the United States.”
German study
In another study, researchers retrospectively identified 215,655 patients with NAFLD or NASH from a German insurance claims database (InGef, 2011-2016) and found 100,644 new events of changing liver severity stages during follow-up. They reported 411 cases (0.4%) of compensated cirrhosis; 20,614 cases (20.5%) of decompensated cirrhosis; 11 cases (0.01%) of LT; and 363 cases (0.4%) of HCC.
Specifically looking at patients diagnosed with advanced liver disease, the mortality rate at 1-year follow-up increased by up to 50% (range 8.8-51.2%), when compared with non-progressive NAFLD/NASH (1.2%, P < .0001). At 5 years, the researchers reported that 2.8% of patients with non-progressive disease died while 14.8% of patients with compensated cirrhosis, 25.6% of patients with decompensated cirrhosis and 64.5% of patients with HCC died. After adjustment for demographics and comorbidities, liver disease progression was linked to significantly increased mortality risk (P < .0001). Specifically, risk of mortality increased by 2.71 with compensated cirrhosis, 4.21 with decompensated cirrhosis, 2.23 with liver transplant and 13.69 with HCC.
“Perhaps most worryingly, during the 5-year study period, 11% of the NAFLD/NASH patients progressed to advanced liver diseases and 17% of [compensated cirrhosis] patients progressed to [decompensated cirrhosis], after accounting for any dying patients,” Ali Canbay, MD, from the University of Magdeburg Medical School in Magdeburg, Germany, said in a press release. “This demonstrates very clearly the need for early detection and effective treatment to prevent progression and potentially reduce mortality.” – by Katrina Altersitz
Reference:
Boursier J. THU-299. Presented at: International Liver Congress; April 10-14, 2019; Vienna, Austria.
Canbay A. PS-060. Presented at: International Liver Congress; April 10-14, 2019; Vienna, Austria.
Disclosures: Boursier reports serving as a consultant for Abbvie, Allergan, Biorad, Diafir, Echosens, Genfit, Gilead Sciences, Inc., Intercept, Native and Siemens. Canbay is an advisor for Gilead Sciences and this study was funded by Gilead Sciences.