Risk factors and timing associated with disease progression and mortality in nonalcoholic fatty liver disease (NAFLD) are not well appreciated.

Loomba and colleagues therefore designed a study to determine the impact of disease severity, demographics and comorbidities on risk of mortality and time to progression in a large, real-world cohort of diagnosed NAFLD patients.

Investigators collected claims data from a 20% Medicare representative sample from 2007 to 2015 and retrospectively analyzed the same. Participants were segregated into the following disease severity groups:

• NAFLD/nonalcoholic steatohepatitis (NASH) alone
• Compensated cirrhosis
• Decompensated cirrhosis
• Liver transplant
• Hepatocellular carcinoma.

Cumulative incidence of mortality and disease progression were estimated for every group and multivariate analyses were done after adjustment for demographics, comorbidities and disease severity.

Overall, 10 826 456 patients were evaluated. NAFLD had a prevalence of 5.7%. Among NAFLD patients, 71.1% had NAFLD/NASH alone while 28.9% had NAFLD cirrhosis. About 85.5% of the patients had hypertension, 84.1% had dyslipidemia, 68.7% had cardiovascular disease and 55.5% had diabetes. The cumulative risk of progression of NAFLD to cirrhosis was estimated as 39%, and that of compensated cirrhosis to decompensated cirrhosis as 45%, over a follow-up period of 8 years. Cardiovascular disease, renal impairment, dyslipidemia and diabetes independently predicted progression. The cumulative risk of mortality for NAFLD, NAFLD cirrhosis, decompensated cirrhosis and hepatocellular carcinoma was 12.6%, 31.1%, 51.4% and 76.2%, respectively.

The study thus suggested that NAFLD is largely underdiagnosed in real-world clinical settings and yields new evidence on the rate of progression of NAFLD and risk factors of mortality across the spectrum of severity of NAFLD and cirrhosis.

 Source: Loomba R, Wong R, Fraysse J, et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther. 2020 May 5.