Public Release:  NASH associated with a 50 percent higher chance of death compared with NAFLD

Large population-based cohort provides important new insights into mortality and cardiovascular disease over the non-alcoholic fatty liver disease spectrum

European Association for the Study of the Liver

April 24, 2015, Vienna, Austria: Results from a large population-based cohort of almost a million people in the UK found that the chances of dying from non-alcoholic steatohepatitis (NASH), over a 14-year period, was approximately 50% higher than for those with non-alcoholic fatty liver disease (NAFLD).

Reported today at The International Liver CongressTM 2015, the large study analysed the overall burden of cardiovascular disease and all-cause mortality across the spectrum of NAFLD. The four stages of NAFLD are steatosis (or simple fatty liver), non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis.

Data from over 900,000 patients in England was obtained from a local computerised hospital activity analysis register. Data was processed to identify patients with NAFLD, NASH and NAFLD cirrhosis throughout the study period. Cardiovascular comorbidities were coded and their prevalence were analysed over 14 years.

During the 14-year study period, 2,701 patients were diagnosed with NAFLD-spectrum conditions: 1,294 with NAFLD, 122 with NASH and 1,285 with cirrhosis. All-cause mortality was higher in people with NASH than NAFLD (22.1% vs 14.5%) and in those with cirrhosis than NAFLD (53.1% vs 14.5%). Congestive cardiac failure was less prevalent in NAFLD than NASH and cirrhosis.

Dr Jake Mann, University of Cambridge, UK, concluded: "Non-alcoholic fatty liver disease is recognised as a risk factor for cardiovascular disease. Our results suggest that non-alcoholic steatohepatitis conveys an even greater risk. This study provides important new insights into mortality and burden of cardiovascular disease in patients across the non-alcoholic fatty liver disease spectrum."

Dr Laurent Castera, Vice-Secretary, European Association for the Study of the Liver, commented: "In non-alcoholic fatty liver disease, fat builds up in the liver which can cause inflammation and, eventually, lead to permanent scarring. Non-alcoholic fatty liver disease has four stages and these findings clearly link the severity of the disease with the increased risk of cardiovascular disease and death. It is therefore imperative that we identify people in the early stages of non-alcoholic fatty liver disease so they can be treated through diet and lifestyle interventions before their condition becomes potentially deadly."

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This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Specialists share research studies and findings, and discuss the hottest topics related to liver disease. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. 2015 is a very special year for EASL and the hepatology community as they will celebrate the 50th annual meeting. The International Liver Congress™ takes place from April 22-26, 2015, Vienna, Austria.

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THE BURDEN OF CARDIOVASCULAR DISEASE AND MORTALITY ACROSS A SPECTRUM OF NON-ALCOHOLIC FATTY LIVER DISEASE: A 14-YEAR FOLLOW-UP POPULATION STUDY OF 929,465 INDIVIDUALS.

Jake P. Mann* 1, Matthew J. Armstrong2, Hardeep Uppal3, Suresh Chandran4, Philip N. Newsome2, Rahul Potluri3

1Paediatrics, University of Cambridge, Cambridge, 2NIHR Centre for Liver Research, University of Birmingham, 3ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, 4Deptartment of acute medicine, North Western Deanery, Manchester, United Kingdom

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is recognised as a risk factor for cardiovascular disease (CVD) with some evidence, albeit from small studies, that non-alcoholic steatohepatitis (NASH) conveys greater risk than NAFLD. In this large UK study we studied the overall burden of CVD and all-cause mortality across the spectrum of NAFLD.

Methods: Anonymous data was obtained from a local computerised hospital activity analysis register regarding a total population of 929,465 patients in England area during 2000-2013. Data was processed using the ACALM (Algorithm for Co-morbidity, Associations, Length of stay and Mortality) study protocol, using ICD-10 codes to identify patients with NAFLD (K76.0), NASH (75.8), and NAFLD cirrhosis (cryptogenic cirrhosis (K74.6)) throughout the study period. Cardiovascular comorbidities were coded according to the ICD-10 criteria and their prevalence were analysed over 14-years.

Results: During the 14-year study period, 2701 patients were diagnosed with NAFLD-spectrum conditions: 1294 with NAFLD, 122 with NASH, and 1285 with cirrhosis. Mean ages at diagnosis were 51±0.4, 52±2 and 59±0.4 years, respectively. All groups had a male predominance (56-58%) and were 78-80% Caucasian. All-cause mortality was higher in NASH than NAFLD (22.1% vs. 14.5%, p=0.025), and in cirrhosis than NAFLD (53.1% vs. 14.5%, p<0.001). Congestive cardiac failure (CCF) was less prevalent in NAFLD than NASH (p=0.001) and cirrhosis (p<0.001). The prevalence of type 2 diabetes mellitus, atrial fibrillation, hyperlipidaemia, chronic kidney disease were higher in the advanced stages of NAFLD [Table 1]. There was no difference in the prevalence of hypertension between the groups.

Conclusions: By utilising a large population based cohort this study provides important new insights into mortality and cardiovascular disease in patients with NAFLD. Notably, during a 14-year study period, death occurs in over 20% of patients diagnosed with NASH and 50% with related-cirrhosis.

Disclosure of Interest: None Declared

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