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Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States.
Hepatology. 2013 Apr; 57(4):1357-65.Hep

Abstract

The clinical and public health significance of nonalcoholic fatty liver disease (NAFLD) is not well established. We investigated the long-term effect of NAFLD on mortality. This analysis utilized the National Health and Nutrition Examination Survey conducted in 1988-1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and FIB-4 score. Of 11,154 participants, 34.0% had NAFLD--the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS <-1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS >0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.93-1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (for NFS: HR, 1.69, 95% CI: 1.09-2.63; for APRI: HR, 1.85, 95% CI: 1.02-3.37; for FIB-4: HR, 1.66, 95% CI: 0.98-2.82) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (for NFS: HR, 3.46, 95% CI: 1.91-6.25; for APRI: HR, 2.53, 95% CI: 1.33-4.83; for FIB-4: HR, 2.68, 95% CI: 1.44-4.99).

CONCLUSIONS

Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23175136

Citation

Kim, Donghee, et al. "Association Between Noninvasive Fibrosis Markers and Mortality Among Adults With Nonalcoholic Fatty Liver Disease in the United States." Hepatology (Baltimore, Md.), vol. 57, no. 4, 2013, pp. 1357-65.
Kim D, Kim WR, Kim HJ, et al. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2013;57(4):1357-65.
Kim, D., Kim, W. R., Kim, H. J., & Therneau, T. M. (2013). Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology (Baltimore, Md.), 57(4), 1357-65. https://doi.org/10.1002/hep.26156
Kim D, et al. Association Between Noninvasive Fibrosis Markers and Mortality Among Adults With Nonalcoholic Fatty Liver Disease in the United States. Hepatology. 2013;57(4):1357-65. PubMed PMID: 23175136.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. AU - Kim,Donghee, AU - Kim,W Ray, AU - Kim,Hwa Jung, AU - Therneau,Terry M, Y1 - 2013/01/25/ PY - 2012/05/04/received PY - 2012/10/16/revised PY - 2012/10/18/accepted PY - 2012/11/24/entrez PY - 2012/11/24/pubmed PY - 2013/7/6/medline SP - 1357 EP - 65 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 57 IS - 4 N2 - UNLABELLED: The clinical and public health significance of nonalcoholic fatty liver disease (NAFLD) is not well established. We investigated the long-term effect of NAFLD on mortality. This analysis utilized the National Health and Nutrition Examination Survey conducted in 1988-1994 and subsequent follow-up data for mortality through December 31, 2006. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known liver diseases. The presence and severity of hepatic fibrosis in subjects with NAFLD was determined by the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and FIB-4 score. Of 11,154 participants, 34.0% had NAFLD--the majority (71.7%) had NFS consistent with lack of significant fibrosis (NFS <-1.455), whereas 3.2% had a score indicative of advanced fibrosis (NFS >0.676). After a median follow-up of 14.5 years, NAFLD was not associated with higher mortality (age- and sex-adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.93-1.19). In contrast, there was a progressive increase in mortality with advancing fibrosis scores. Compared to subjects without fibrosis, those with a high probability of advanced fibrosis had a 69% increase in mortality (for NFS: HR, 1.69, 95% CI: 1.09-2.63; for APRI: HR, 1.85, 95% CI: 1.02-3.37; for FIB-4: HR, 1.66, 95% CI: 0.98-2.82) after adjustment for other known predictors of mortality. These increases in mortality were almost entirely from cardiovascular causes (for NFS: HR, 3.46, 95% CI: 1.91-6.25; for APRI: HR, 2.53, 95% CI: 1.33-4.83; for FIB-4: HR, 2.68, 95% CI: 1.44-4.99). CONCLUSIONS: Ultrasonography-diagnosed NAFLD is not associated with increased mortality. However, advanced fibrosis, as determined by noninvasive fibrosis marker panels, is a significant predictor of mortality, mainly from cardiovascular causes, independent of other known factors. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/23175136/Association_between_noninvasive_fibrosis_markers_and_mortality_among_adults_with_nonalcoholic_fatty_liver_disease_in_the_United_States_ L2 - https://doi.org/10.1002/hep.26156 DB - PRIME DP - Unbound Medicine ER -