Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort.
Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort.
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DOI：
10.1136/gutjnl-2020-322786
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发表时间：
2021-07
期刊：
影响因子：
24.5
通讯作者：
Ludvigsson JF
中科院分区：
文献类型：
--
作者：
Simon TG;Roelstraete B;Khalili H;Hagström H;Ludvigsson JF
缺乏关于非酒精性脂肪性肝病（NAFLD）整个组织学谱的总体和病因特异性死亡率风险的基于人群的数据。这项全国性的匹配队列研究包括瑞典所有活检证实的NAFLD患者（1966-2017; n= 10，568）。NAFLD从提交给瑞典28个病理部门的所有肝活检中得到组织学证实，排除了肝脏疾病的其他病因，并进一步分类为单纯性脂肪变性、非纤维化脂肪性肝炎（NASH）、非硬化性纤维化和肝硬化。NAFLD病例按年龄、性别、日历年和县与≤5名一般人群对照者匹配（n= 49，925）。使用考克斯回归，我们估计了多变量校正的风险比（aHR）和95%CI。在平均14.2年的时间里，有4,338名NAFLD患者死亡。与对照组相比，NAFLD患者的总体死亡率显著增加（16.9 vs. 28.6/1000人-年[PY];差异=11.7/1000 PY; aHR=1.93，95%CI=1.86-2.00）。与对照组相比，单纯性脂肪变性患者的死亡风险显著增加（8.3/1000 PY，aHR=1.71，95%CI=1.64-1.79），非纤维化NASH（13.4/1000 PY，aHR=2.14，95%CI=1.93-2.38），非骨化性纤维化（18.4/1000 PY，aHR=2.44，95%CI=2.22-2.69）和肝硬化（53.6/1000 PY，aHR=3.79，95%CI=3.34-4.30）（P趋势<0.01）。当单纯性脂肪变性为参照时，这种剂量依赖性梯度是相似的（P趋势<0.01）。与NAFLD相关的额外死亡率主要来自肝外癌（4.5/1000 PY; aHR=2.16，95%CI=2.03-2.30），其次为肝硬化（2.7/1000 PY; aHR=18.15，95%CI=14.78-22.30），心血管疾病（1.4/1000 PY; aHR=1.35，95%CI=1.26-1.44）和肝细胞癌（HCC）（1.2/1000 PY; aHR=11.12，95%CI=8.65-14.30）。所有NAFLD组织学分期均与总体死亡率显著增加相关，并且这种风险随着NAFLD组织学恶化而逐渐增加。这种超额死亡率大部分来自肝外癌和肝硬化，而相比之下，心血管疾病和HCC的贡献不大。
Population-based data are lacking regarding the risk of overall and cause-specific mortality across the complete histological spectrum of nonalcoholic fatty liver disease (NAFLD). This nationwide, matched cohort study included all individuals in Sweden with biopsy-confirmed NAFLD (1966–2017; n=10,568). NAFLD was confirmed histologically from all liver biopsies submitted to Sweden’s 28 pathology departments, after excluding other etiologies of liver disease, and further categorized as, simple steatosis, non-fibrotic steatohepatitis (NASH), non-cirrhotic fibrosis and cirrhosis. NAFLD cases were matched to ≤5 general population comparators by age, sex, calendar year and county (n=49,925). Using Cox regression, we estimated multivariable-adjusted hazard ratios (aHRs) and 95%CIs. Over a median of 14.2 years, 4,338 NAFLD patients died. Compared to controls, NAFLD patients had significantly increased overall mortality (16.9 vs. 28.6/1000 person-years [PY]; difference=11.7/1000PY; aHR=1.93, 95%CI=1.86–2.00). Compared to controls, significant excess mortality risk was observed with simple steatosis (8.3/1000PY, aHR=1.71, 95%CI=1.64–1.79), non-fibrotic NASH (13.4/1000PY, aHR=2.14, 95%CI=1.93–2.38), non-cirrhotic fibrosis (18.4/1000PY, aHR=2.44, 95%CI=2.22–2.69) and cirrhosis (53.6/1000PY, aHR=3.79, 95%CI=3.34–4.30)(Ptrend<0.01). This dose-dependent gradient was similar when simple steatosis was the reference (Ptrend<0.01). The excess mortality associated with NAFLD was primarily from extra-hepatic cancer (4.5/1000PY; aHR=2.16, 95%CI=2.03–2.30), followed by cirrhosis (2.7/1000PY; aHR=18.15, 95%CI=14.78–22.30), cardiovascular disease (1.4/1000PY; aHR=1.35, 95%CI=1.26–1.44) and hepatocellular carcinoma (HCC)(1.2/1000PY; aHR=11.12, 95%CI=8.65–14.30). All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extra-hepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.
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影响因子：
1.6
作者：
Golabi P;Otgonsuren M;de Avila L;Sayiner M;Rafiq N;Younossi ZM
通讯作者：
Younossi ZM
影响因子：
13.5
作者：
Kim, Donghee;Kim, W. Ray;Kim, Hwa Jung;Therneau, Terry M.
通讯作者：
Therneau, Terry M.
DOI：
10.1136/bmj.d6891
发表时间：
2011-11-18
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Lazo M;Hernaez R;Bonekamp S;Kamel IR;Brancati FL;Guallar E;Clark JM
通讯作者：
Clark JM
影响因子：
29.4
作者：
Angulo P;Kleiner DE;Dam-Larsen S;Adams LA;Bjornsson ES;Charatcharoenwitthaya P;Mills PR;Keach JC;Lafferty HD;Stahler A;Haflidadottir S;Bendtsen F
通讯作者：
Bendtsen F
影响因子：
2
作者：
Austin PC;Fine JP
通讯作者：
Fine JP