Hannes Hagström1,2, Patrik Nasr3, Mattias Ekstedt3, Stergios Kechagias3, Per Stål1,2, Pierre Bedossa4, Rolf Hultcrantz1,2. 1. a Division of Hepatology, Center for Digestive Diseases , Karolinska University Hospital , Stockholm , Sweden. 2. b Department of Medicine , Huddinge, Karolinska Institutet , Stockholm , Sweden. 3. c Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden. 4. d Department of Pathology, Hôpital Beaujon , University Paris Diderot , Paris , France.
Abstract
BACKGROUND AND AIMS: A new score for the histological severity of nonalcoholic fatty liver disease (NAFLD), called SAF (Steatosis, Activity and Fibrosis) has been developed. We aimed to evaluate the impact of this score on overall mortality. METHODS: We used data from 139 patients with biopsy-proven NAFLD. All biopsies were graded according to the SAF scoring system and disease severity was classified as mild, moderate or severe. Causes of death were extracted from a national, population-based register. A Cox regression model, adjusted for sex, body mass index (BMI) and diabetes mellitus type 2, was applied. RESULTS: At baseline 35 patients presented with mild or moderate disease respectively, and 69 patients with severe disease. During follow-up (median 25.3 years, range 1.7-40.8) 74 patients died, 11 in the mild group (31%), 18 in the moderate group (51%) and 45 in the severe group (65%), p = .002. Compared to patients with mild disease, patients with moderate disease did not have a significant increase in overall mortality (HR 1.83, 95%CI 0.89-3.77, p = .10). Patients with severe disease had a significant increase in mortality (HR 2.65, 95%CI 1.19-5.93, p = .017). However, when adjusting for fibrosis stage, significance was lost (HR 1.85, 95%CI 0.76-4.54, p = .18). NASH, defined as per the FLIP algorithm, was not associated with mortality compared to not having NASH (HR 1.46, 95%CI 0.74-2.90, p = .28). CONCLUSIONS: After adjustment for fibrosis, the SAF score was not associated with increased mortality in NAFLD. This finding should be corroborated in larger cohorts with similar follow-up time.
BACKGROUND AND AIMS: A new score for the histological severity of nonalcoholic fatty liver disease (NAFLD), called SAF (Steatosis, Activity and Fibrosis) has been developed. We aimed to evaluate the impact of this score on overall mortality. METHODS: We used data from 139 patients with biopsy-proven NAFLD. All biopsies were graded according to the SAF scoring system and disease severity was classified as mild, moderate or severe. Causes of death were extracted from a national, population-based register. A Cox regression model, adjusted for sex, body mass index (BMI) and diabetes mellitus type 2, was applied. RESULTS: At baseline 35 patients presented with mild or moderate disease respectively, and 69 patients with severe disease. During follow-up (median 25.3 years, range 1.7-40.8) 74 patients died, 11 in the mild group (31%), 18 in the moderate group (51%) and 45 in the severe group (65%), p = .002. Compared to patients with mild disease, patients with moderate disease did not have a significant increase in overall mortality (HR 1.83, 95%CI 0.89-3.77, p = .10). Patients with severe disease had a significant increase in mortality (HR 2.65, 95%CI 1.19-5.93, p = .017). However, when adjusting for fibrosis stage, significance was lost (HR 1.85, 95%CI 0.76-4.54, p = .18). NASH, defined as per the FLIP algorithm, was not associated with mortality compared to not having NASH (HR 1.46, 95%CI 0.74-2.90, p = .28). CONCLUSIONS: After adjustment for fibrosis, the SAF score was not associated with increased mortality in NAFLD. This finding should be corroborated in larger cohorts with similar follow-up time.
Authors: Katharina Staufer; Emina Halilbasic; Walter Spindelboeck; Magdalena Eilenberg; Gerhard Prager; Vanessa Stadlbauer; Andreas Posch; Petra Munda; Rodrig Marculescu; Barbara Obermayer-Pietsch; Judith Stift; Carolin Lackner; Michael Trauner; Rudolf E Stauber Journal: United European Gastroenterol J Date: 2019-07-12 Impact factor: 4.623
Authors: Zobair M Younossi; Maria Stepanova; Nila Rafiq; Linda Henry; Rohit Loomba; Hala Makhlouf; Zachary Goodman Journal: Hepatol Commun Date: 2017-06-06
Authors: Jason C Simeone; Jay P Bae; Byron J Hoogwerf; Qian Li; Axel Haupt; Ayad K Ali; Marilyn K Boardman; Beth L Nordstrom Journal: Clin Epidemiol Date: 2017-12-14 Impact factor: 4.790