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

BMC Medicine

A. Katrina Loomis¹  William Alazawi²  Stuart Kendrick³  Myriam Alexander⁴  Naveed Sattar⁵  Dawn M. Waterworth⁶  Daniel Prieto-Alhambra⁷  Johan van der Lei⁸  Peter Rijnbeek⁸  Mees Mosseveld⁸  Talita Duarte-Salles⁹  Alessandro Pasqua^1,10  Francesco Lapi^1,10  David Ansell^1,11 

[1] 0000 0000 8800 7493, grid.410513.2, Worldwide Research and Development, Pfizer, Genome Sciences and Technologies, New York, USA;0000 0001 2161 2573, grid.4464.2, Barts Liver Centre, Blizard Institute, Queen Mary, University of London, London, UK;0000 0001 2162 0389, grid.418236.a, GlaxoSmithKline, Medicines Research Centre, Cambridge, UK;0000 0001 2162 0389, grid.418236.a, Real World Data, GlaxoSmithKline, Uxbridge, UK;0000 0001 2193 314X, grid.8756.c, University of Glasgow, Glasgow, UK;0000 0004 0393 4335, grid.418019.5, Genetics, GlaxoSmithKline, Collegeville, PA, USA;0000 0004 1936 8948, grid.4991.5, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK;000000040459992X, grid.5645.2, Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands;Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain;Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy;Quintile IMS, London, UK;

关键词: Cirrhosis;    Hepatocellular cancer;    NAFLD;    NASH;    Population;   

DOI  :  10.1186/s12916-019-1321-x

来源: publisher

【 摘 要 】

BackgroundNon-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.MethodsData 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.ResultsOut 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.ConclusionsReal-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.

【 授权许可】

CC BY