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| Pàgina inicial > Articles > Articles publicats > Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis : |
(Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas) (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria)) (Instituto de Investigación Hospital Universitario de la Princesa) (Hospital General Universitario de Valencia) (Institut d'Investigació Biomèdica Sant Pau) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Hospital Universitari Vall d'Hebron) (Biocruces Bizkaia) (Hospital Universitari i Politècnic La Fe (València)) (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas)
| Data: | 2021 |
| Resum: | Background and Aim: Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD). Methods: Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score ≥4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4. 7 ± 3. 8 years). Results: Fibrosis was F0 34. 3% (649/1893), F1 27% (511/1893), F2 16. 5% (312/1893), F3 15% (284/1893) and F4 7. 2% (137/1893). NASH diagnosis 51. 9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33. 6%) to F2 (68. 6%), and decreased significantly in F4 patients (51. 8%) (P =. 0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96. 2% [945/982] vs. 95. 2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89. 1% [311/349]) (P <. 0001). Progression to cirrhosis was similar between NASH (9. 5% [51/539]) and indeterminate NASH (7. 9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8. 417; P =. 015). Death and decompensated cirrhosis were similar between these. Conclusions: The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death. |
| Ajuts: | Instituto de Salud Carlos III PI19/01404 Instituto de Salud Carlos III PI16/01842 Instituto de Salud Carlos III PI17/00535 Instituto de Salud Carlos III GLD19/00100 |
| Nota: | Altres ajuts: Consejería de Salud de la Junta de Andalucía (PI-0075-2014). |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Matèria: | Ballooning ; Fatty liver disease ; Inflammation ; Metabolic-associated fatty liver disease ; Natural coursesteatohepatitis ; Steatosis |
| Publicat a: | Liver International, Vol. 41 Núm. 9 (september 2021) , p. 2076-2086, ISSN 1478-3231 |
