Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis: A longitudinal study of 1893 biopsy-proven nonalcoholic fatty liver disease subjects
Por:
Ampuero, J, Aller, R, Gallego-Duran, R, Crespo, J, Abad, J, Gonzalez-Rodriguez, A, Gomez-Camarero, J, Caballeria, J, Lo Iacono, O, Ibanez, L, Garcia-Samaniego, J, Martin-Mateos, R, Frances, R, Fernandez-Rodriguez, C, Diago, M, Soriano, G, Andrade, RJ, Latorre, R, Jorquera, F, Morillas, RM, Escudero, D, Estevez, P, Hernandez-Guerra, M, Augustin, S, Pareja-Megia, MJ, Banales, JM, Aspichueta, P, Benlloch, S, Rosales, JM, Salmeron, J, Turnes, J, Romero-Gomez, M
Publicada:
1 sep 2021
Ahead of Print:
1 may 2021
Resumen:
Background and Aim Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD).
Methods Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score >= 4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4.7 +/- 3.8 years).
Results Fibrosis was F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) and F4 7.2% (137/1893). NASH diagnosis 51.9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33.6%) to F2 (68.6%), and decreased significantly in F4 patients (51.8%) (P = .0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96.2% [945/982] vs. 95.2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89.1% [311/349]) (P < .0001). Progression to cirrhosis was similar between NASH (9.5% [51/539]) and indeterminate NASH (7.9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8.417; P = .015). Death and decompensated cirrhosis were similar between these.
Conclusions The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death.
Filiaciones:
Ampuero, J:
Univ Seville, Hosp Univ Virgen Rocio, Seville, Spain
Inst Biomed Sevilla, SeLiver Grp, Seville, Spain
CIBEREHD, Madrid, Spain
Aller, R:
Univ Valladolid, Hosp Clin Univ Valladolid, Ctr Invest Endocrinol & Nutr, Valladolid, Spain
Gallego-Duran, R:
Inst Biomed Sevilla, SeLiver Grp, Seville, Spain
CIBEREHD, Madrid, Spain
Crespo, J:
Hosp Univ Marques Valdecilla, Digest Dept, Santander, Spain
Abad, J:
Hosp Univ Puerta Hierro, Digest Dept, Madrid, Spain
Gonzalez-Rodriguez, A:
Hosp Univ Santa Cristina, Liver Res Unit, Inst Invest Sanitaria Princesa, Madrid, Spain
Gomez-Camarero, J:
Hosp Univ Burgos, Digest Dept, Burgos, Spain
Caballeria, J:
CIBEREHD, Madrid, Spain
Inst Invest Biomed August Pi & Sunyer IDIBPAS, Hosp Clin, Liver Unit, Barcelona, Spain
Lo Iacono, O:
Hosp Univ Tajo, Digest Dept, Aranjuez, Spain
Ibanez, L:
CIBEREHD, Madrid, Spain
Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
Garcia-Samaniego, J:
CIBEREHD, Madrid, Spain
Hosp Univ La Paz, IDIPAZ, Madrid, Spain
Martin-Mateos, R:
CIBEREHD, Madrid, Spain
Hosp Univ Ramon y Cajal, Digest Dept, Madrid, Spain
Frances, R:
CIBEREHD, Madrid, Spain
Univ Miguel Hernandez, Hosp Gen Univ Alicante, Elche, Spain
Fernandez-Rodriguez, C:
Univ Rey Juan Carlos, Hosp Univ Fdn Alcorcon, Mostoles, Spain
Diago, M:
Hosp Gen Univ Valencia, Digest Dept, Valencia, Spain
Soriano, G:
CIBEREHD, Madrid, Spain
Hosp Santa Creu & Sant Pau, Digest Dept, Barcelona, Spain
Andrade, RJ:
CIBEREHD, Madrid, Spain
Univ Malaga, Inst Invest Biomed Malaga IBIMA, Hosp Univ Virgen Victoria, Unidad Gest Clin Enfermedades Digest, Malaga, Spain
Latorre, R:
Hosp Univ Son Llatzer, Digest Dept, Mallorca, Spain
Jorquera, F:
CIBEREHD, Madrid, Spain
Complejo Asistencial Univ Leon, Serv Aparato Digest, IBIOMED, Leon, Spain
Morillas, RM:
CIBEREHD, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Digest Dept, Badalona, Spain
Escudero, D:
Univ Valencia, Hosp Clin Univ Valencia, Valencia, Spain
Estevez, P:
Complejo Hosp Univ Vigo, Digest Dept, Vigo, Spain
Hernandez-Guerra, M:
Hosp Univ Canarias, Digest Dept, Santa Cruz De Tenerife, Spain
Augustin, S:
Hosp Valle De Hebron, Digest Dept, Barcelona, Spain
Pareja-Megia, MJ:
Hosp Univ Virgen Valme, Pathol Dept, Seville, Spain
Banales, JM:
CIBEREHD, Madrid, Spain
Univ Basque Country UPV EHU, Dept Liver & Gastrointestinal Dis, Biodonostia Res Inst, Ikerbasque,Donostia Univ Hosp, San Sebastian, Spain
Aspichueta, P:
CIBEREHD, Madrid, Spain
Univ Basque Country UPV EHU, Biocruces Res Inst, Fac Med & Nursing, Dept Physiol, Leioa, Spain
Benlloch, S:
CIBEREHD, Madrid, Spain
Hosp Univ & Politecn La Fe, Digest Dept, Valencia, Spain
Rosales, JM:
Agencia Sanitaria Costa Sol, Digest Dept, Marbella, Spain
Salmeron, J:
Hosp Univ San Cecilio, Digest Dept, Granada, Spain
Turnes, J:
Complejo Hosp Pontevedra, Digest Dept, Pontevedra, Spain
Romero-Gomez, M:
Univ Seville, Hosp Univ Virgen Rocio, Seville, Spain
Inst Biomed Sevilla, SeLiver Grp, Seville, Spain
CIBEREHD, Madrid, Spain
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