부산대학교 도서관

Introduction and Objectives: Fibrosis stage is the most important prognostic factor in non-alcoholic fatty liver disease (NAFLD). Although liver biopsy is the gold standard for staging fibrosis, it is a difficult tool to use on follow-up evaluations. Non-invasive tests (NITs) were developed to first stratify patients at risk for advanced fibrosis but were not validated for follow-up. This study aimed to evaluate liver fibrosis progression, NITs variations over time and their correlation with clinical outcomes (hepatic decompensation, hepatic and extra-hepatic neoplasm; cardiovascular events and mortality). Materials and Methods: Retrospective cohort of 138 patients with biopsy proven non-alcoholic steatohepatitis (NASH). Patients underwent clinical, physical, and laboratory examinations and NIT assessments (FIB-4 and transient elastography - TE). Fibrosis progression was estimated using TE. NIT variations over time were compared with the development of clinical outcomes. Results: 138 patients were analyzed. The median age was 65 years and the median body mass index was 32Kg/m² at diagnosis. Seventy-seven patients (55%) had diabetes and 82 (59%) had hypertension at diagnosis. Fifty-six patients (40%) had advanced fibrosis (≥F3) and 18 (13%) of them had cirrhosis at biopsy. The median time of follow-up was 10 years. One hundred nineteen patients performed TE at the end of the follow-up. Fifty-nine patients progressed to cirrhosis (49,6%). Initial NAFLD activity score (NAS) was statistically associated with fibrosis progression. Twenty-four patients (17%) developed a clinical outcome. The fibrosis stage at diagnosis was associated with cirrhosis decompensation but not associated with cardiovascular events. Fibrosis progression assessed with elastography (>11,5kPa) was associated with portal hypertension development. FIB-4 elevation during follow-up (>2,7) was associated with cirrhosis decompensation. Conclusions: High-risk NAFLD patients have a high prevalence of fibrosis progression and clinical outcomes. NITs such as FIB-4 and TE might be useful tools for the evaluation of disease progression and risk of hepatic decompensation. More prospective studies are needed to better define NITs cut-offs for risk of clinical outcomes.