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Hospital admission with non-alcoholic fatty liver disease is associated with increased all-cause mortality independent of cardiovascular risk factors

By Jake P Mann, Paul Carter, Matthew J. Armstrong, Hesham K Abdelaziz, Hardeep Uppal, Billal Patel, Suresh Chandran, Ranjit More, Philip N. Newsome, Rahul Potluri

Posted 30 Dec 2019
medRxiv DOI: 10.1101/2019.12.24.19015750

BackgroundNon-alcoholic fatty liver disease (NAFLD) is common and strongly associated with the metabolic syndrome. Though NAFLD may progress to end-stage liver disease, the top cause of mortality in NAFLD is cardiovascular disease (CVD). Most of the data on liver-related mortality in NAFLD derives from specialist liver centres. We aimed to assess mortality in NAFLD when adjusting for CVD in a real world cohort of inpatients. MethodsRetrospective study of hospitalised patients with 14-years follow-up. NAFL (non-alcoholi c fatty liver), non-alcoholic steatohepatitis (NASH), and NAFLD-cirrhosis groups were defined by ICD-10 codes using ACALM methodology. Cases were age-/sex-matched 1:10 with non-NAFLD hospitalised patients from the ACALM registry. All-cause mortality was compared between groups using cox regression adjusted for CVD and metabolic syndrome risk factors. ResultsWe identified 1238 patients with NAFL, 105 with NASH and 1235 with NAFLD-cirrhosis. There was an increasing burden of cardiovascular disease with progression from NAFL to NASH to cirrhosis. After adjustment for demographics, metabolic syndrome components and cardiovascular disease, patients with NAFL, NASH, and cirrhosis all had increased all-cause mortality (HR 1.3 (CI 1.1-1.5), HR 1.5 (CI 1.0-2.3) and HR 3.5 (CI 3.3-3.9), respectively). Hepatic decompensation (NAFL HR 8.0 (CI 6.1-10.4), NASH HR 6.5 (2.7-15.4) and cirrhosis HR 85.8 (CI 72-104)), and hepatocellular carcinoma were increased in all NAFLD groups. ConclusionThere is a high burden of cardiovascular disease in NAFLD-cirrhosis patients. From a large "real-life" non-specialist registry of hospitalized patients, NAFLD patients have increased overall mortality and rate of liver-related complications compared to controls after adjusting for cardiovascular disease.

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