SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2017/12  
 
  2017 Dec;67(6):1265-1273.  
  doi: 10.1016/j.jhep.2017.07.027.  
 
  Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD  
 
  Hagström H, Nasr P, Ekstedt M, Hammar U, Stål P, Hultcrantz R, Kechagias S  
  https://www.ncbi.nlm.nih.gov/pubmed/28803953  
 
 

Abstract

BACKGROUND & AIMS:

Non-alcoholic fatty liver disease (NAFLD) is very common in the general population, but identifying patients with increased risk of mortality and liver-specific morbidity remains a challenge. Non-alcoholic steatohepatitis (NASH) is thought to enhance this risk; therefore, resolution of NASH is a major endpoint in current pharmacologic studies. Herein, we aim to investigate the long-term prognosis of a large cohort of NAFLD patients, and to study the specific effect of NASH and fibrosis stage on prognosis.

METHODS:

We conducted a retrospective cohort study of 646 biopsy-proven NAFLD patients. Each case was matched for age, sex and municipality to ten controls. Outcomes on mortality and severe liver disease, defined as cirrhosis, liver decompensation/failure or hepatocellular carcinoma, were evaluated using population-based registers. Cox regression models adjusted for age, sex and type 2 diabetes were used to examine the long-term risk according to fibrosis stage. Likelihood ratio tests were used to assess whether adding NASH to these models increased the predictive capacity. Laplace regression was used to estimate the time to severe liver disease according to stage of fibrosis.

RESULTS:

During a follow-up of mean 20years (range 0-40) equivalent to 139,163 person-years, 12% of NAFLD patients and 2.2% of controls developed severe liver disease (p<0.001). Compared to controls, the risk of severe liver disease increased per stage of fibrosis (hazard ratio ranging from 1.9 in F0 to 104.9 in F4). Accounting for the presence of NASH did not change these estimates significantly (likelihood ratio test >0.05 for all stages of fibrosis). Similar results were seen for overall mortality. The lower end of the 95% confidence interval for the 10th percentile of time to development of severe liver disease was 22-26years in F0-1, 9.3years in F2, 2.3years in F3, and 0.9years to liver decompensation in F4.

CONCLUSIONS:

In this, the largest ever study of biopsy-proven NAFLD, the presence of NASH did not increase the risk of liver-specific morbidity or overall mortality. Knowledge of time to development of severe liver disease according to fibrosis stage can be used in individual patient counselling and for public health decisions.

LAY SUMMARY:

Non-alcoholic fatty liver disease (NAFLD) is very common in the general population, but reaching an accurate prognosis remains challenging. We investigate the long-term prognosis of a large cohort of NAFLD patients. In this, the largest ever study of biopsy-proven NAFLD, the presence of NASH did not increase the risk of liver-specific morbidity or overall mortality. Knowledge of time to development of severe liver disease according to fibrosis stage can be used in individual patient counselling and for public health decisions.

 

  
Question posée
 
Identification des patients présentant un risque accru de mortalité et de morbidité hépatique chez les patients ayant une stéatose hépatique non alcoolique (NASH).
  
Question posée
 
Plus grande étude jamais réalisée chez des patients présentant une stéatose hépatique non alcoolique avec preuve histologique, la présence de la NASH n'a pas augmenté le risque de morbidité spécifique liée au foie ou de mortalité globale, contrairement au stade de la fibrose qui intervient sur ces deux paramètres.
  
Commentaires

Cette très large cohorte permet de rassurer les très nombreux patients avec une NASH sans fibrose significative et bien surveiller ceux avec fibrose évoluée.
 
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