October 19, 2013

Nonalcoholic Fatty Liver Disease: What's the Long-Term Prognosis?

October 18, 2013

Atif Zaman, MD, MPH Reviewing Angulo P et al., Gastroenterology 2013 Oct 145:782

Pending further validation, the NAFLD fibrosis score shows promise in predicting patients' risks for complications, transplantation, and death.

Several simple noninvasive scoring systems have been developed using routinely measured clinical and laboratory variables to differentiate nonalcoholic fatty liver disease (NAFLD) with and without advanced fibrosis (NEJM JW Gastroenterol Dec 4 2009). However, no studies to date have determined if these scoring systems predict long-term outcomes.

Now, researchers have examined this issue in a retrospective study of 320 well-characterized patients with biopsy-proven NAFLD treated in multiple, international centers. Based on calculations of four validated scoring systems, the NAFLD fibrosis score, the aspartate aminotransferase (AST)/platelet ratio index, the FIB-4 score, and the BARD score, patients were categorized into low-, intermediate-, and high-risk groups. Outcomes included liver-related complications, transplantation, or death.

Fourteen percent of patients developed liver-related complications, and 13% died or underwent liver transplantation during a median follow-up of 104.8 months (range, 3–317 months). Characterizations of intermediate and high risks versus low risk were associated with increased likelihood of liver-related complications using the NAFLD fibrosis score (adjusted hazard ratios, 7.7 and 34.2, respectively), the AST/platelet ratio index (aHRs, 8.8 and 20.9), and the BARD score (aHRs, 6.2 and 6.6). Characterizations of intermediate and high risks versus low risk were associated with increased likelihood of death or transplantation only using the NAFLD fibrosis score (aHRs, 4.2 and 9.8).


Despite the typical inherent biases associated with the retrospective study design, these findings demonstrate that previously validated, simple, noninvasive nonalcoholic fatty liver disease scoring systems are able to predict long-term, liver-related complications and — in the case of the NAFLD fibrosis score — long-term survival and need for liver transplantation. With further validation of these findings, clinicians can use a scoring system such as the NAFLD fibrosis score to counsel NAFLD patients, and researchers can use it as the study endpoint in NAFLD treatment trials.

Editor Disclosures at Time of Publication

    Disclosures for Atif Zaman, MD, MPH at time of publicationSpeaker’s bureauBristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex


    Angulo P et al. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2013 Oct; 145:782. (http://dx.doi.org/10.1053/j.gastro.2013.06.057)


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