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Predictors of advanced fibrosis in non-cirrhotic non-alcoholic fatty liver disease in Germany

Lookup NU author(s): Professor Quentin AnsteeORCiD


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© 2018 John Wiley & Sons Ltd 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 gender distribution) were included. The prevalence of fibrosis stage 3 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 exhibited arterial hypertension (78% vs 50%, P = 0.001) and type 2 diabetes (61% vs 24.1%, P < 0.001) more frequently. 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. Conclusion: 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.

Publication metadata

Author(s): Labenz C, Huber Y, Kalliga E, Nagel M, Ruckes C, Straub BK, Galle PR, Worns M-A, Anstee QM, Schuppan D, Schattenberg JM

Publication type: Article

Publication status: Published

Journal: Alimentary Pharmacology and Therapeutics

Year: 2018

Volume: 48

Issue: 10

Pages: 1109-1116

Print publication date: 01/11/2018

Online publication date: 04/10/2018

Acceptance date: 16/08/2018

ISSN (print): 0269-2813

ISSN (electronic): 1365-2036

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/apt.14976


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