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- Foie
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Très original
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Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/04  
 
  2016 Apr;63(4):1170-83  
  doi: 10.1002/hep.28390  
 
  Noninvasive fatty liver markers predict liver disease mortality in the U.S. population.  
 
  Unalp-Arida A, Ruhl CE  
  http://www.ncbi.nlm.nih.gov/pubmed/26663021  
 
 

Nonalcoholic fatty liver disease (NAFLD) contributes to premature death along with obesity, diabetes, and cardiovascular disease (CVD). We examined whether hepatic steatosis (HS) on ultrasound and liver enzyme activities were associated with increased liver disease mortality in the U.S. National Health and Nutrition Examination Survey (NHANES), 1988-1994, with up to 23 years of linked-mortality data. Survey-linked National Death Index records were analyzed among 14,527 adult participants who were negative for viral hepatitis B and C and iron overload. HS on ultrasound was categorized as normal, mild, moderate, or severe. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) elevation was defined as the highest sex-specific decile. Cumulative mortality was 36.2% from all causes, including 16.3% from CVD, 10.8% from cancer, 5.4% from diabetes, and 1.1% from liver disease. Severe HS was associated with increased liver disease mortality in both age-adjusted (hazard ratio [HR]: 3.92; 95% confidence interval [CI]: 1.49-10.27; P for trend: 0.011) and multivariate-adjusted analyses (HR, 2.68; 95% CI: 1.02-7.03; P for trend: 0.072). HS was not independently associated with mortality from all causes, CVD, cancer, or diabetes. Higher liver disease mortality was found with elevated ALT (HR, 4.08; 95% CI: 1.99-8.33), AST (HR, 4.33; 95% CI: 2.18-8.59), and GGT (HR, 7.91; 95% CI: 3.06-20.46). GGT elevation was associated with increased overall mortality (HR, 1.45; 95% CI: 1.21-1.74). Liver enzymes were otherwise unrelated to overall or cause-specific mortality.

CONCLUSIONS:

In the U.S. population, severe hepatic steatosis on ultrasound and liver enzyme elevation were associated with increased liver disease mortality, but were not independently associated with mortality from all causes (except for GGT), CVD, cancer, or diabetes. (Hepatology 2016;63:1170-1183).

 
Question posée
 
La stéatose hépatique évaluée par échographie et l’activité des transaminases et de la GGT est-elle associée à une augmentation de la mortalité hépatique dans une population américaine (cohorte NHANES de 1988-1994) ?
 
Question posée
 
La mortalité cumulée toute cause était de 36,2% dont 1,1% de maladies du foie. La stéatose sévère était associée à l’augmentation de mortalité par cause hépatique ajustée à l’âge (hazard ratio [HR]: 3,92; 95% confidence interval [CI]: 1,49-10,27; P : 0.011) et par analyse multi-variée (HR, 2,68; 95% CI: 1,02-7,03; P : 0,072). Cette mortalité hépatique plus élevée était associée à une augmentation de l’ALAT (HR, 4,08; 95% CI:1,99-8,33), de l’ASAT (HR, 4,33; 95% CI: 2,18-8,59), et des GGT (HR, 7,91; 95% CI: 3,06-20,46).
 
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