Independent Predictors of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease
published online 26 June 2009.
Background & Aims
Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. We investigated factors associated with advanced fibrosis in NAFLD.
Methods
The study included 432 patients with histologically proven NAFLD (26.8% with nonalcoholic steatohepatitis [NASH] and 17.4% with moderate-to severe fibrosis). NASH was defined as steatosis, lobular inflammation, and ballooning degeneration with or without Mallory–Denk bodies and/or fibrosis. Fibrosis was classified into 2 groups: those with no or minimal fibrosis and those with moderate-to-severe fibrosis. Groups were compared using Mann–Whitney and chi-square method analyses. A model was constructed using a stepwise bidirectional method; its predictive power was measured using a 10-fold cross-validation technique.
Results
Patients with NASH were more likely to be male (P < .0001); have lower hip-to-waist ratios (P = .03); were less likely to be African American (P = .06); have higher levels of alanine aminotransferase (ALT; P < .0001), aspartate aminotransferase (AST; P < .0001), and serum triglycerides (P = .0154), but lower levels of high-density lipoprotein cholesterol (P < .0001). Patients with moderate-to-severe fibrosis were older (P = .0245); more likely to be male (P = .0189), Caucasian (P = .0382), have diabetes mellitus (P = .0238), and hypertension (P = .0375); and have a lower hip-to-waist ratio (P = .0077) but higher serum AST (P < .0001) and ALT (P < .0001) levels. The multivariate analysis model to predict moderate-to-severe fibrosis included male sex, Caucasian ethnicity, diabetes mellitus, and increased AST and ALT levels (model P value < .0001).
Conclusions
In patients with NAFLD, diabetes mellitus and aminotransferase levels are independent predictors of moderate-to-severe fibrosis. They can be used to identify NAFLD patients at risk for advanced fibrosis.
⁎Center for Liver Diseases, Inova Fairfax Hospital, Fairfax, Virginia
‡Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
§Armed Forces Institute of Pathology, Washington, District of Columbia
Reprint requests Address requests for reprints to: Zobair M. Younossi, MD, MPH, Center for Liver Diseases at Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, Virginia 22042. fax: (703) 776-4388
Conflicts of interest The authors disclose no conflicts.
Funding This study was supported in part by the Liver Disease Outcomes Fund of the Center for Liver Diseases at Inova Fairfax Hospital, Inova Health System.
ABSTRACT
Independent Predictors of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease