Non-alcoholic fatty liver disease natural history, complications and prognosis: Difference between revisions

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Revision as of 03:47, 25 June 2023

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

If left untreated non-alcoholic fatty liver disease may progress to fibrosis and, later cirrhosis. Studies of serial liver biopsies estimate a 26-37% rate of hepatic fibrosis and 2-15% rate of cirrhosis in less than 6 years. Common complications of NAFLD include fibrosis, cirrhosis, internal bleeding, encephalopathy. The presence of fibrosis and cirrhosis associated with a particularly poor prognosis among patients with NAFLD.

Natural History, Complications and Prognosis

Natural History

The symptoms of NAFLD usually develop in the 40th decade of life, and usually asymptomatic at first.
After following NAFLD patients for long-term the outcome of the disease is as follows
- 1) Patients with NAFLD has overall high morbidity and mortality rate and the common cause of death in NAFLD patients is cardiovascular disease.
- 2) Patients with NASH has more liver-related mortality rate
If left untreated, patients with NAFLD may progress to develop hepato-cellular carcinoma (HCC). But it is directly propotional to the degree of fibrosis and advanced cirrhosis
Children who are positive with NAFLD are also prone to short lifespan when compared to general population.^[1]

Complications

Common complications of NAFLD include:^[2]^[3]
- Fibrosis
- Cirrhosis. Amon patients with both hepatic steatosis and elevated liver function tests, the incidence rate of cirrhosis is 3.37 (95% CI: 2.34-4.86) per 1000 1000 person-years.
- Internal bleeding
- Encepholopathy

Non-alcoholic fatty liver disease, especially if with cirrhosis, may be associated with thrombocytopenia^[4]^[5].

Prognosis

Depending on the extent of the fibrosis and cirrhosis at the time of diagnosis, the prognosis may vary.^[6]
Histology is the most reliable means to grade the severity of the disease and thus estimate prognosis.
The presence of fibrosis and cirrhosis associated with a particularly poor prognosis among patients with NAFLD. ^[7]
In a cohort study of patient who had biopsy-proven NAFLD, 6% developed death, hepatocellular carcinoma, or death with 5 years^[8].

References

↑ Calzadilla Bertot L, Adams LA (2016). "The Natural Course of Non-Alcoholic Fatty Liver Disease". Int J Mol Sci. 17 (5). doi:10.3390/ijms17050774. PMC 4881593. PMID 27213358.
↑ Chacko KR, Reinus J (2016). "Extrahepatic Complications of Nonalcoholic Fatty Liver Disease". Clin Liver Dis. 20 (2): 387–401. doi:10.1016/j.cld.2015.10.004. PMID 27063276.
↑ Vanni E, Marengo A, Mezzabotta L, Bugianesi E (2015). "Systemic Complications of Nonalcoholic Fatty Liver Disease: When the Liver Is Not an Innocent Bystander". Semin Liver Dis. 35 (3): 236–49. doi:10.1055/s-0035-1562944. PMID 26378641.
↑ Rivera-Álvarez M, Córdova-Ramírez AC, Elías-De-La-Cruz GD, Murrieta-Álvarez I, León-Peña AA, Cantero-Fortiz Y; et al. (2021). "Non-alcoholic fatty liver disease and thrombocytopenia IV: its association with granulocytopenia". Hematol Transfus Cell Ther. doi:10.1016/j.htct.2021.06.004. PMID 34312112 Check |pmid= value (help).
↑ Panke CL, Tovo CV, Villela-Nogueira CA, Cravo CM, Ferreira FC, Rezende GFM; et al. (2020). "Evaluation of thrombocytopenia in patients with non-alcoholic fatty liver disease without cirrhosis". Ann Hepatol. 19 (1): 88–91. doi:10.1016/j.aohep.2019.05.011. PMID 31575467.
↑ Suman, A.; Khullar, V.; Limaye, A. (2016). "Complications of Non-Alcoholic Fatty Liver Disease". Journal of Hepatology. 64 (2): S473. doi:10.1016/S0168-8278(16)00798-4. ISSN 0168-8278.
↑ Jepsen P, Grønbæk H (2011). "Prognosis and staging of non-alcoholic fatty liver disease". BMJ. 343: d7302. doi:10.1136/bmj.d7302. PMID 22102440.
↑ Mózes FE, Lee JA, Vali Y, Alzoubi O, Staufer K, Trauner M; et al. (2023). "Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis". Lancet Gastroenterol Hepatol. doi:10.1016/S2468-1253(23)00141-3. PMID 37290471 Check |pmid= value (help).

Template:WS Template:WH

[pmid27213358-1] Calzadilla Bertot L, Adams LA (2016). "The Natural Course of Non-Alcoholic Fatty Liver Disease". Int J Mol Sci. 17 (5). doi:10.3390/ijms17050774. PMC 4881593. PMID 27213358.

[pmid27063276-2] Chacko KR, Reinus J (2016). "Extrahepatic Complications of Nonalcoholic Fatty Liver Disease". Clin Liver Dis. 20 (2): 387–401. doi:10.1016/j.cld.2015.10.004. PMID 27063276.

[pmid26378641-3] Vanni E, Marengo A, Mezzabotta L, Bugianesi E (2015). "Systemic Complications of Nonalcoholic Fatty Liver Disease: When the Liver Is Not an Innocent Bystander". Semin Liver Dis. 35 (3): 236–49. doi:10.1055/s-0035-1562944. PMID 26378641.

[pmid34312112-4] Rivera-Álvarez M, Córdova-Ramírez AC, Elías-De-La-Cruz GD, Murrieta-Álvarez I, León-Peña AA, Cantero-Fortiz Y; et al. (2021). "Non-alcoholic fatty liver disease and thrombocytopenia IV: its association with granulocytopenia". Hematol Transfus Cell Ther. doi:10.1016/j.htct.2021.06.004. PMID 34312112 Check |pmid= value (help).

[pmid31575467-5] Panke CL, Tovo CV, Villela-Nogueira CA, Cravo CM, Ferreira FC, Rezende GFM; et al. (2020). "Evaluation of thrombocytopenia in patients with non-alcoholic fatty liver disease without cirrhosis". Ann Hepatol. 19 (1): 88–91. doi:10.1016/j.aohep.2019.05.011. PMID 31575467.

[SumanKhullar2016-6] Suman, A.; Khullar, V.; Limaye, A. (2016). "Complications of Non-Alcoholic Fatty Liver Disease". Journal of Hepatology. 64 (2): S473. doi:10.1016/S0168-8278(16)00798-4. ISSN 0168-8278.

[pmid22102440-7] Jepsen P, Grønbæk H (2011). "Prognosis and staging of non-alcoholic fatty liver disease". BMJ. 343: d7302. doi:10.1136/bmj.d7302. PMID 22102440.

[pmid37290471-8] Mózes FE, Lee JA, Vali Y, Alzoubi O, Staufer K, Trauner M; et al. (2023). "Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis". Lancet Gastroenterol Hepatol. doi:10.1016/S2468-1253(23)00141-3. PMID 37290471 Check |pmid= value (help).

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@@ Line 29: / Line 29: @@
 * Histology is the most reliable means to grade the severity of the disease and thus estimate prognosis.
 * The presence of [[fibrosis]] and [[cirrhosis]] associated with a particularly poor prognosis among patients with NAFLD. <ref name="pmid22102440">{{cite journal| author=Jepsen P, Grønbæk H| title=Prognosis and staging of non-alcoholic fatty liver disease. | journal=BMJ | year= 2011 | volume= 343 | issue=  | pages= d7302 | pmid=22102440 | doi=10.1136/bmj.d7302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22102440  }} </ref>
+* In a cohort study of patient who had biopsy-proven NAFLD, 6% developed death, hepatocellular carcinoma, or death with 5 years<ref name="pmid37290471">{{cite journal| author=Mózes FE, Lee JA, Vali Y, Alzoubi O, Staufer K, Trauner M | display-authors=etal| title=Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. | journal=Lancet Gastroenterol Hepatol | year= 2023 | volume=  | issue=  | pages=  | pmid=37290471 | doi=10.1016/S2468-1253(23)00141-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37290471  }} </ref>.
 ==References==