Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD : real-world study of 18 million patients in four European cohorts
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). Here we used healthcare records of 18 million adults to estimate risk of acquiring advanced liver disease diagnoses in patients with NAFLD or NASH compared to individually matched controls.
METHODS: Data were extracted from four European primary care databases representing the UK, Netherlands, Italy and Spain. Patients with a recorded diagnosis of NAFLD or NASH (NAFLD/NASH) were followed up for incident cirrhosis and HCC diagnoses. Each coded NAFLD/NASH patient was matched to up to 100 "non-NAFLD" patients by practice site, gender, age ± 5 years and visit recorded within ± 6 months. Hazard ratios (HR) were estimated using Cox models adjusted for age and smoking status and pooled across databases by random effects meta-analyses.
RESULTS: Out of 18,782,281 adults, we identified 136,703 patients with coded NAFLD/NASH. Coded NAFLD/NASH patients were more likely to have diabetes, hypertension and obesity than matched controls. HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43-9.19) and for HCC, 3.51 (95% CI 1.72-7.16). HR for either outcome was higher in patients with NASH and those with high-risk Fib-4 scores. The strongest independent predictor of a diagnosis of HCC or cirrhosis was baseline diagnosis of diabetes.
CONCLUSIONS: Real-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasising the need to identify specific groups of patients at highest risk.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
BMC medicine - 17(2019), 1 vom: 20. Mai, Seite 95 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Alexander, Myriam [VerfasserIn] |
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| Links: |
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| Themen: |
Cirrhosis |
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| Anmerkungen: |
Date Completed 19.11.2019 Date Revised 19.04.2022 published: Electronic CommentIn: BMC Med. 2019 Jul 4;17(1):123. - PMID 31269936 Citation Status MEDLINE |
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| doi: |
10.1186/s12916-019-1321-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM297231499 |
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| 100 | 1 | |a Alexander, Myriam |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD |b real-world study of 18 million patients in four European cohorts |
| 264 | 1 | |c 2019 | |
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| 500 | |a Date Completed 19.11.2019 | ||
| 500 | |a Date Revised 19.04.2022 | ||
| 500 | |a published: Electronic | ||
| 500 | |a CommentIn: BMC Med. 2019 Jul 4;17(1):123. - PMID 31269936 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). Here we used healthcare records of 18 million adults to estimate risk of acquiring advanced liver disease diagnoses in patients with NAFLD or NASH compared to individually matched controls | ||
| 520 | |a METHODS: Data were extracted from four European primary care databases representing the UK, Netherlands, Italy and Spain. Patients with a recorded diagnosis of NAFLD or NASH (NAFLD/NASH) were followed up for incident cirrhosis and HCC diagnoses. Each coded NAFLD/NASH patient was matched to up to 100 "non-NAFLD" patients by practice site, gender, age ± 5 years and visit recorded within ± 6 months. Hazard ratios (HR) were estimated using Cox models adjusted for age and smoking status and pooled across databases by random effects meta-analyses | ||
| 520 | |a RESULTS: Out of 18,782,281 adults, we identified 136,703 patients with coded NAFLD/NASH. Coded NAFLD/NASH patients were more likely to have diabetes, hypertension and obesity than matched controls. HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43-9.19) and for HCC, 3.51 (95% CI 1.72-7.16). HR for either outcome was higher in patients with NASH and those with high-risk Fib-4 scores. The strongest independent predictor of a diagnosis of HCC or cirrhosis was baseline diagnosis of diabetes | ||
| 520 | |a CONCLUSIONS: Real-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasising the need to identify specific groups of patients at highest risk | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Cirrhosis | |
| 650 | 4 | |a Hepatocellular cancer | |
| 650 | 4 | |a NAFLD | |
| 650 | 4 | |a NASH | |
| 650 | 4 | |a Population | |
| 700 | 1 | |a Loomis, A Katrina |e verfasserin |4 aut | |
| 700 | 1 | |a van der Lei, Johan |e verfasserin |4 aut | |
| 700 | 1 | |a Duarte-Salles, Talita |e verfasserin |4 aut | |
| 700 | 1 | |a Prieto-Alhambra, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Ansell, David |e verfasserin |4 aut | |
| 700 | 1 | |a Pasqua, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Lapi, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Rijnbeek, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Mosseveld, Mees |e verfasserin |4 aut | |
| 700 | 1 | |a Waterworth, Dawn M |e verfasserin |4 aut | |
| 700 | 1 | |a Kendrick, Stuart |e verfasserin |4 aut | |
| 700 | 1 | |a Sattar, Naveed |e verfasserin |4 aut | |
| 700 | 1 | |a Alazawi, William |e verfasserin |4 aut | |
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