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Simple Noninvasive Systems Predict Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease
Open accessAbstract
Background & aims Some patients with nonalcoholic fatty liver disease (NAFLD) develop liver-related complications and have higher mortality than other patients with NAFLD. We determined the accuracy of simple, noninvasive scoring systems in identification of patients at increased risk for liver-related complications or death.Methods We performed a retrospective, international, multicenter cohort study of 320 patients diagnosed with NAFLD, based on liver biopsy analysis through 2002 and followed through 2011. Patients were assigned to mild-, intermediate-, or high-risk groups based on cutoff values for 2 of the following: NAFLD fibrosis score, aspartate aminotransferase/platelet ratio index, FIB-4 score, and BARD score. Outcomes included liver-related complications and death or liver transplantation. We used multivariate Cox proportional hazard regression analysis to adjust for relevant variables and calculate adjusted hazard ratios (aHRs).Results During a median follow-up period of 104.8 months (range, 3-317 months), 14% of patients developed liver-related events and 13% died or underwent liver transplantation. The aHRs for liver-related events in the intermediate-risk and high-risk groups, compared with the low-risk group, were 7.7 (95% confidence interval [CI]: 1.4-42.7) and 34.2 (95% CI: 6.5-180.1), respectively, based on NAFLD fibrosis score; 8.8 (95% CI: 1.1-67.3) and 20.9 (95% CI: 2.6-165.3) based on the aspartate aminotransferase/platelet ratio index; and 6.2 (95% CI: 1.4-27.2) and 6.6 (95% CI: 1.4-31.1) based on the BARD score. The aHRs for death or liver transplantation in the intermediate-risk and high-risk groups compared with the low-risk group were 4.2 (95% CI: 1.3-13.8) and 9.8 (95% CI: 2.7-35.3), respectively, based on the NAFLD fibrosis scores. Based on aspartate aminotransferase/platelet ratio index and FIB-4 score, only the high-risk group had a greater risk of death or liver transplantation (aHR = 3.1; 95% CI: 1.1-8.4 and aHR = 6.6; 95% CI: 2.3-20.4, respectively).Conclusions Simple noninvasive scoring systems help identify patients with NAFLD who are at increased risk for liver-related complications or death. NAFLD fibrosis score appears to be the best indicator of patients at risk, based on HRs. The results of this study require external validation.
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“Six retrospective cohort studies on individuals with biopsy-proven MASLD showed that NFS and FIB-4 predict the occurrence of liver-related events (AUROCs from 0.72 to 0.86) and overall mortality (AUROCs from 0.67 to 0.82), 176,177 with a similar or lower accuracy compared to histology.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [176]
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Ekstedt, M., Hagström, H., Nasr, P., Fredrikson, M., Stål, P., Kechagias, S., & Hultcrantz, R. (2015) · Hepatology · doi:10.1002/hep.27368 · Cited by 2,287
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210
Estes, C., Anstee, Q. M., Arias, M., Bantel, H., Bellentani, S., Caballería, J., Colombo, M., Craxì, A., Crespo, J., Day, C. P., et al. (2018) · Journal of Hepatology · doi:10.1016/j.jhep.2018.05.036 · Cited by 2,046
Berzigotti, A., Tsochatzis, E., Boursier, J., Castera, L., Cazzagon, N., Friedrich-Rust, M., Petta, S., & Thiele, M. (2021) · Journal of Hepatology · doi:10.1016/j.jhep.2021.05.025 · Cited by 1,925
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Metadata
- Authors
- Angulo, P., Bugianesi, E., Bjornsson, E. S., Charatcharoenwitthaya, P., Mills, P. R., Barrera, F., Haflidadottir, S., Day, C. P., & George, J.
- Affiliations
- University of Kentucky HealthCare (US)
- University of Turin (IT)
- National University Hospital of Iceland (IS)
- Siriraj Hospital (TH)
- Gartnavel General Hospital (GB)
- Newcastle University (GB)
- The University of Sydney (AU)
- Corresponding author
- Angulo, Paul
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 145
- Issue
- 4
- Pages
- 782-789.e4
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC3931256
- OpenAlex
- W2129639561
- Cited by
- 502
- References
- 32
- Citations by year
- 2026: 7 · 2025: 29 · 2024: 31 · 2023: 32 · 2022: 46 · 2021: 60 · 2020: 49 · 2019: 40 · 2018: 39 · 2017: 35 · 2016: 36 · 2015: 49 · 2014: 45 · 2013: 4
- FWCI
- 32.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institutes of Health (R01 DK82426)
- Seventh Framework Programme (HEALTH-F2-2009-241762)
- National Health and Medical Research Council (1049857, 632630)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, NAFLD fibrosis score, FIB-4, BARD score, liver complications, mortality, liver transplantation, disease progression, prognosis, liver fibrosis, risk stratification, prognostic accuracy
- MeSH terms
- Adult, Fatty Liver, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Cohort Studies, Kaplan-Meier Estimate, Non-alcoholic Fatty Liver Disease
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