Christian Labenz1, Yvonne Huber1, Eva Kalliga1, Michael Nagel1, Christian Ruckes2, Beate K Straub3, Peter R Galle1, Marcus-Alexander Wörns1, Quentin M Anstee4,5, Detlef Schuppan6, Jörn M Schattenberg1. 1. Department of Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 2. Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 3. Institute of Pathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 4. Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. 5. Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK. 6. Institute of Translational Immunology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Abstract
BACKGROUND: Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non-alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non-cirrhotic NAFLD is difficult to identify and data from Germany are lacking. AIM: To identify clinical factors associated with advanced, non-cirrhotic fibrosis. METHODS: Patients were recruited in the prospectively enrolling European NAFLD Registry. Clinical characteristics and the performance of non-invasive surrogate scores compared with vibration-controlled transient elastography are reported. RESULTS: Two hundred and sixty-one patients with non-cirrhotic NAFLD on liver biopsy (mean age 51 years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50 years, P < 0.01), had a higher body mass index (32.3 vs 30.5, P < 0.05), and more frequent arterial hypertension (78% vs 50%, P = 0.001) and type 2 diabetes (61% vs 24.1%, P < 0.001). On multivariate logistic regression, diabetes (OR = 4.68, 95% CI 2.17-10.10) and hypertension (OR = 2.91, 95% CI 1.12-7.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an AUROC of 0.81 (95% CI 0.72-0.91). The performance of NAFLD fibrosis score, Fibrosis-4, and AST to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively. CONCLUSIONS: The prevalence of metabolic comorbidities in a German population with non-cirrhotic biopsy-proven NAFLD is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood-based non-invasive surrogate scores in ruling out advanced fibrosis.
BACKGROUND: Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non-alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non-cirrhotic NAFLD is difficult to identify and data from Germany are lacking. AIM: To identify clinical factors associated with advanced, non-cirrhotic fibrosis. METHODS:Patients were recruited in the prospectively enrolling European NAFLD Registry. Clinical characteristics and the performance of non-invasive surrogate scores compared with vibration-controlled transient elastography are reported. RESULTS: Two hundred and sixty-one patients with non-cirrhotic NAFLD on liver biopsy (mean age 51 years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50 years, P < 0.01), had a higher body mass index (32.3 vs 30.5, P < 0.05), and more frequent arterial hypertension (78% vs 50%, P = 0.001) and type 2 diabetes (61% vs 24.1%, P < 0.001). On multivariate logistic regression, diabetes (OR = 4.68, 95% CI 2.17-10.10) and hypertension (OR = 2.91, 95% CI 1.12-7.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an AUROC of 0.81 (95% CI 0.72-0.91). The performance of NAFLD fibrosis score, Fibrosis-4, and AST to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively. CONCLUSIONS: The prevalence of metabolic comorbidities in a German population with non-cirrhotic biopsy-proven NAFLD is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood-based non-invasive surrogate scores in ruling out advanced fibrosis.
Authors: Yvonne Huber; Christian Labenz; Maurice Michel; Marcus-A Wörns; Peter R Galle; Karel Kostev; Jörn M Schattenberg Journal: Dtsch Arztebl Int Date: 2020-10-23 Impact factor: 5.594
Authors: Javier A Tamargo; Kenneth E Sherman; Adriana Campa; Sabrina S Martinez; Tan Li; Jacqueline Hernandez; Colby Teeman; Raul N Mandler; Jun Chen; Richard L Ehman; Marianna K Baum Journal: Am J Clin Nutr Date: 2021-03-11 Impact factor: 8.472
Authors: Christian Labenz; Jürgen H Prochaska; Yvonne Huber; Michael Nagel; Beate K Straub; Philipp Wild; Peter R Galle; Jörn M Schattenberg Journal: Hepatol Commun Date: 2019-09-30