Original ResearchFull Report: Clinical—LiverLiver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease
Section snippets
Patients and Methods
This was a longitudinal, international, multicenter cohort study. Patients were identified retrospectively by reviewing the pathology database at each participating center of subjects with the pathology diagnosis of steatosis, steatohepatitis, or fatty liver. After an extensive review of the patients’ medical records including all notes from clinic visits, laboratory and imaging data, and liver biopsy reports, only patients with the diagnosis of NAFLD were included in the analysis, as described
Baseline Characteristics
Of the 859 patients, 240 were excluded (Supplementary Figure 1), leaving 619 patients for analysis. Supplementary Figure 2 illustrates the number of liver biopsies performed by calendar year period. Table 1 describes the baseline clinical and laboratory characteristics of the 619 patients. The median age was 49 years (IQR, 38–60), and the median BMI was 30.7 kg/m2 (IQR, 26.4–36.5 kg/m2). There was a predominance of white race, approximately two thirds were women, and approximately a third of
Discussion
Our study showed, first, fibrosis stage independently, and regardless of the presence or severity of other histologic features, is the most relevant liver biopsy feature associated with overall- and liver-related mortality/liver transplantation or liver-related events. This effect was seen even with the earliest stages of fibrosis detectable by microscopic examination, and even when individuals with advanced (fibrosis stages 3–4) disease were excluded. Second, the presence of fibrosis rather
Acknowledgment
The authors thank Dr Oscar Arauz (School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia) and Dr Ananya Pongpaibul (Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand) for their invaluable help in collecting the data for this study. Drs Arauz and Pongpaibul did not receive compensation in association with their contributions to this article.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by a National Institute of Health R01 DK82426 grant. This study was supported in part by the Intramural Research Program of the National Institutes of Health, National Cancer Institute. The sponsor played no role in the study design or the collection, analysis, and interpretation of data.