番茄社区

VIENNA -- When patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) progress to cirrhosis, that's when things get truly ugly, a researcher said here.

Mortality rates in a French cohort jumped from 5% among patients with simple NAFLD/NASH to 18% among patients with compensated cirrhosis, suggesting cirrhosis is a "turning point" in the progression of liver disease, reported Jérôme Boursier, MD, PhD, of Angers University Hospital in Angers, France.

In addition, 84% of patients with cirrhosis at baseline had experienced a decompensated event, suggesting that these patients are being identified "too late."

At a press conference at the European Association for the Study of the Liver (EASL) annual meeting, Boursier argued that NAFLD/NASH are not "benign conditions," citing a recent that found a global prevalence of NASH of 25%. But the "natural history of the disease is not totally known," he added.

Press conference moderator Philip Newsome, PhD, EASL vice-secretary and a researcher at the University of Birmingham in England, said that past studies on NAFLD/NASH may have painted a misleading picture.

"Previously, much of the data came from specialized tertiary care centers, which by definition often get the sickest patients, so that would overrepresent the prevalence ... in terms of it being worse than it actually is. The benefit of seeing real world data is it gives you a sense check as to what's happening outside the ivory towers," he told 番茄社区.

Zobair Younossi, MD, of Inova Health System in Falls Church, Virginia, who was not involved with the research, commented at the press conference that "there's always a bias" in studies from tertiary care centers, and that Boursier's study "is consistent with data from death records in the U.S.," as well as NHANES data from the CDC that shows NAFLD death rates are increasing.

Boursier and colleagues examined data from adults ages ≥18 in the French national database for hospital care () from 2009-2015, which records all hospitalizations in France. NAFLD/NASH diagnosis was defined via ICD-10 codes. Because this was "a cohort of real life," there was no way to differentiate NAFLD from NASH, since it was only based on physician codes, Boursier said.

These patients were divided into four cohorts:

• Simple NAFLD/NASH
• Compensated cirrhosis
• Decompensated cirrhosis
• Hepatocellular carcinoma

Overall, there were about 125,000 patients with NAFLD/NASH. Of these, about 1,000 had compensated cirrhosis, about 8,000 had decompensated cirrhosis, and about 1,100 had hepatocellular carcinoma. There were about 7,000 deaths (about 5% of the entire cohort) over the study period.

The authors also noted high rates of comorbidities in the cohort, as ≥47% had hypertension, ≥43% had diabetes, ≥41% had cardiovascular disease, and ≥21% had renal impairment.

The 7-year mortality rate was higher among the NAFLD/NASH cohort compared to the expected rate for the "general similarly aged" population (7.9% vs around 5%, respectively), the researchers found. Rates were 18% among patients with compensated cirrhosis, about 35% in patients with decompensated cirrhosis, and 48% with hepatocellular carcinoma.

After 7 years, 5% of NAFLD/NASH patients progressed to either compensated or decompensated cirrhosis. While Boursier acknowledged 5% as a "small range," he added that given the large amount of patients in the database, it was a "high number" of patients who ended up with these complications.

Adding to the finding that cirrhosis marks a turning point in the natural history of the disease, Boursier said that after 7 years, about 28% of patients with compensated cirrhosis progressed to decompensated cirrhosis.

Because a significant portion of NAFLD/NASH patients are late stage patients, "we need strategies for early identification of patients at risk for developing liver-related complications," Boursier said.

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