Patients with NAFLD exhibit more advanced fibrosis in liver biopsy than patients with other chronic liver diseases

Abstract

Introduction Despite extremely high and seemingly rising prevalence of non-alcoholic fatty liver disease (NAFLD), awareness for this health condition is still low. In the present study we analyzed, if this is reflected in clinical routine for advanced diagnostic measures.

Methods Retrospective data of 93 patients with histologically determined fibrosis stage and confirmed etiology was analyzed. Patients were grouped according to chronic liver disease alone (n=40), concomitant chronic liver disease and NAFLD (n=29), or NAFLD alone (n=24). Fibrosis stage and presence of cirrhosis were main outcome measures.

Results Patients with NAFLD were significantly older and had significantly higher body mass index and CAP-values than patients with chronic liver disease. Significantly higher fibrosis stages were observed in patients with NAFLD than in those with chronic liver disease alone (p=0.003). Presence of cirrhosis was significantly higher in patients with NAFLD than in patients with chronic liver disease (p=0.01). This was not associated with a significantly different age distribution over fibrosis stages between chronic liver disease and NAFLD. Undergoing liver biopsy 10 years earlier could have possibly prevented progression to cirrhosis in up to 7 patients with NAFLD. This could have potentially saved 35,000 € yearly health care resources.

Conclusion These findings suggest that the time course for development of liver fibrosis and cirrhosis is not fundamentally different between patients with NAFLD or with other chronic liver diseases. Higher rates of cirrhosis observed in patients with NAFLD could potentially be ameliorated by earlier diagnostic work-up and improved monitoring. 

Zusammenfassung

Einleitung Trotz der extrem hohen und anscheinend steigenden Prävalenz der nichtalkoholischen Fettlebererkrankung (NAFLD) ist das Bewusstsein für diese Erkrankung immer noch gering. In der vorliegenden Studie wurde untersucht, ob sich dies in der klinischen Routine für weiterführende diagnostische Maßnahmen niederschlägt.

Methoden Retrospektiv erhobene Daten von 93 Patienten mit histologisch bestimmtem Fibrosestadium und bestätigter Ätiologie wurden analysiert. Die Patienten wurden nach chronischer Lebererkrankung ohne NAFLD (n=40), gleichzeitiger chronischer Lebererkrankung und NAFLD (n=29) oder ausschließlich NAFLD (n=24) eingeteilt. Das Fibrosestadium und das Vorhandensein einer Zirrhose waren die zentralen klinischen Endpunkte.

Ergebnisse Patienten mit NAFLD waren signifikant älter und hatten einen signifikant höheren Body Mass Index und CAP-Werte als Patienten mit anderen chronischen Lebererkrankungen. Bei Patienten mit NAFLD wurden signifikant höhere Fibrosestadien beobachtet als bei Patienten mit anderen chronischen Lebererkrankung (p=0,003). Zirrhose lag bei Patienten mit NAFLD signifikant häufiger vor als bei Patienten mit anderen chronischen Lebererkrankungen (p=0,01). Dies war nicht mit einer signifikant unterschiedlichen Altersverteilung über die Fibrosestadien verbunden. Eine 10 Jahre früher durchgeführte Leberbiopsie hätte möglicherweise bei bis zu 7 Patienten mit NAFLD das Fortschreiten zur Zirrhose verhindern können. Dadurch hätten möglicherweise 35.000 € an Gesundheitskosten pro Jahr eingespart werden können.

Schlussfolgerung Diese Ergebnisse deuten darauf hin, dass sich der zeitliche Verlauf der Entwicklung von Leberfibrose und Zirrhose bei Patienten mit NAFLD oder anderen chronischen Lebererkrankungen nicht grundlegend unterscheidet. Die bei Patienten mit NAFLD beobachteten höheren Zirrhoseraten könnten möglicherweise durch eine frühere diagnostische Abklärung und eine bessere Überwachung gemindert werden.

Schlüsselwörter

chronische Lebererkrankung - NAFLD - Leberfibrose - Leberzirrhose - Gesundheitskosten

Keywords

chronic liver disease - NAFLD - liver fibrosis - liver cirrhosis - health care cost

Publication History

Received: 12 October 2022

Accepted after revision: 23 November 2022

Article published online:
09 January 2023

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