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Younossi ZM, Stepanova M, Rafiq N, et al. Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease. Hepatol Commun. 2017;1(5):421-428doi: 10.1002/hep4.1054.
Younossi, Z. M., Stepanova, M., Rafiq, N., Henry, L., Loomba, R., Makhlouf, H., & Goodman, Z. (2017). Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease. Hepatology communications, 1(5), 421-428. https://doi.org/10.1002/hep4.1054
Younossi, Zobair M, et al. "Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease." Hepatology communications vol. 1,5 (2017): 421-428. doi: https://doi.org/10.1002/hep4.1054
Younossi ZM, Stepanova M, Rafiq N, Henry L, Loomba R, Makhlouf H, Goodman Z. Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease. Hepatol Commun. 2017 Jun 06;1(5):421-428. doi: 10.1002/hep4.1054. eCollection 2017 Jul. PMID: 29404470; PMCID: PMC5721410.
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Hepatol Commun. 2017 Jun 06;1(5):421-428. doi: 10.1002/hep4.1054. eCollection 2017 Jul.

Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease.

Hepatology communications

Zobair M Younossi, Maria Stepanova, Nila Rafiq, Linda Henry, Rohit Loomba, Hala Makhlouf, Zachary Goodman

Affiliations

  1. Center for Liver Diseases, Department of Medicine Inova Fairfax Hospital Falls Church VA.
  2. Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA.
  3. Center for Outcomes Research in Liver Diseases Washington DC.
  4. NAFLD Research Center University of California San Diego San Diego CA.
  5. Cancer Diagnosis Program, National Cancer Institute National Institutes of Health Bethesda MD.

PMID: 29404470 PMCID: PMC5721410 DOI: 10.1002/hep4.1054

Abstract

Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD). The minimal pathologic criteria for NASH include hepatic steatosis, ballooning degeneration, and lobular inflammation. The resolution of NASH, which relies on the loss of ballooning degeneration, is subject to sampling and observer variability in pathologic interpretation. Ballooning is associated with advanced hepatic fibrosis in cross-sectional studies but is not a predictor of mortality in NAFLD. Fibrosis staging, while still subject to some sampling variability, has less observer variability and is a robust predictor of liver-related mortality in NAFLD. In this study, we hypothesize that, regardless of the diagnosis of NASH, the presence of steatofibrosis (steatosis accompanied by fibrosis) regardless of other pathologic features can also be a robust predictor of mortality in NAFLD. We used our previously reported cohort of patients with NAFLD with liver biopsies and long-term mortality follow-up. Cox proportional hazard models were used to determine the predictors of overall and liver-related mortality. Of 209 enrolled NAFLD subjects, 97 can be classified as having steatofibrosis. During follow-up (median 150 months), 64 (30.6%) patients died, with 18 (8.6%) from liver-related causes. Adjusted for age, both diagnostic categories of NASH and steatofibrosis were significantly and similarly associated with liver-related mortality (adjusted hazard ratio [aHR], 9.9; 95% confidence interval (CI), 1.3-74.9;

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