Incidence and Predictors of Liver-Related Events in Patients With Nonalcoholic Fatty Liver Disease

Shalimar; Sabreena S Sheikh; Sagnik Biswas; Manas Vaishnav; Piyush Pathak; Aditya V Pachisia; Himanshu Narang; Shubham Prasad; Shubham Mehta; Anugrah Dhooria; Shekhar Swaroop; Rithvik Golla; Ankit Agarwal; Ramesh Kumar; Subrat K Acharya

doi:10.1016/j.jceh.2022.09.007

Incidence and Predictors of Liver-Related Events in Patients With Nonalcoholic Fatty Liver Disease

J Clin Exp Hepatol. 2023 Jan-Feb;13(1):37-47. doi: 10.1016/j.jceh.2022.09.007. Epub 2022 Oct 5.

Authors

Shalimar¹, Sabreena S Sheikh¹, Sagnik Biswas¹, Manas Vaishnav¹, Piyush Pathak¹, Aditya V Pachisia¹, Himanshu Narang¹, Shubham Prasad¹, Shubham Mehta¹, Anugrah Dhooria¹, Shekhar Swaroop¹, Rithvik Golla¹, Ankit Agarwal¹, Ramesh Kumar², Subrat K Acharya^{1

3

4}

Affiliations

¹ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India.
³ Pro-Chancellor, KIIT University, Bhubaneshwar, Odisha, 751024, India.
⁴ Executive Director Gastroenterology, Fortis Escorts Digestive & Liver Institute, Okhla, New Delhi, India.

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is the commonest type of liver disease worldwide. We aimed to assess the incidence and predictors of liver-related events (LREs) and mortality in NAFLD patients.

Methods: NAFLD patients (n = 957) evaluated between January 2000 and November 2021 were included. Patients were categorised as noncirrhosis (NC), compensated cirrhosis (CC) and decompensated cirrhosis (DC), and the incidence of LRE and mortality were estimated and compared.

Results: The proportions of NC, CC and DC were 87.8% (n = 840), 8.8% (n = 84) and 3.4% (n = 33), respectively. The median follow-up duration was 3.9 (3.0-5.7) years, and the total cumulative duration was 4633 person-years. The incidence of LRE per 100 person-years was 0.14, 2.72 and 10.24 in patients with NC, CC and DC, respectively. The incidence of mortality was 0.12, 1.05 and 4.24 per 100 person-years, respectively, in the 3 groups. The causes of mortality in the 3 groups were liver related in 1/5 (20%), 3/4 (75%) and 6/9 (66.7%), respectively. Overall, the mortality rate was higher in those with diabetes than those without diabetes (log-rank P value = 0.005). On further analysis, diabetes was associated with poor outcomes only in NC group (log-rank P value = 0.036), and not in CC (log-rank P value = 0.353) or DC groups (log-rank P value = 0.771). On multivariate Cox proportional hazard analysis, age (hazard ratio [HR] 1.070), hypertension (HR 4.361) and DC (HR 15.036) were independent predictors of poor outcomes. Liver stiffness measurement, bilirubin, CC and DC were independent predictors of LRE.

Conclusion: In our study of NAFLD from India, the incidence of LRE was found to be similar to that seen in Western studies. In NC NAFLD, diabetes was associated with poor outcomes.

Keywords: ALT, alanine aminotransferase; AST, aspartate aminotransferase; CC, compensated cirrhosis; DC, decompensated cirrhosis; ESLD, end-stage liver disease; GI, gastrointestinal; HCC, hepatocellular carcinoma; HE, hepatic encephalopathy; HR, hazard ratio; LRE, liver-related events; LSM, liver stiffness measurement; MAFLD; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NC, noncirrhosis; alcohol; decompensation; metabolic syndrome; portal hypertension.