Long-term outcomes of non-alcoholic fatty liver disease

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver disease worldwide and affects a third of Western populations. The rising prevalence of NAFLD has been associated with an in increased incidence of complications of cirrhosis such as hepatocellular carcinoma and death and is associated with worrying healthcare and economic burden. The natural history of NAFLD is varied and remains incompletely understood. Long-term, large cohort studies with diversity of disease severity are required to further understanding and improve management of NAFLD. Aims and Methods This study aimed to describe the clinical characteristics of a large UK based NAFLD cohort and explore the frequency and predictors of significant clinical events. Participants were identified from the Newcastle Hospitals historical clinical database and the European NAFLD Registry who met the eligibility criteria and had at least 12 months follow up. Results Six hundred and five patients were included with a mean follow-up time of 11.8 ± 7.3 years. One hundred and sixteen (19.2%) were cirrhotic at baseline, which increased to 166 (32.9%) by the final clinical event. Co-morbidities such as T2DM, HTN and the metabolic syndrome were common, and the incidence of these rose over the follow-up period. One hundred and twelve patients died over the course of the study; liver disease was the most common cause of death (28.6%). Factors that were prognostic for all-cause mortality included fibrosis stage at baseline (aHR 8.31, 95% CI 4.31-16.01), T2DM (aHR 1.98, 95% CI 1.25-3.14), IHD (aHR 2.31, 95% CI 1.27-4.20) and “high risk” FIB-4 (aHR 10.02, 95% CI 6.14-16.35). Conclusion This thesis describes a large, well-characterised NAFLD cohort over a follow-up period of up to 35 years. Factors that predicted adverse outcomes were identified including T2DM, IHD and FIB-4 scores, which could help clinicians identify individuals at risk of poor outcomes.