Abstract
Background: The clinical burden and natural history of non-alcoholic fatty liver disease (NAFLD) vary globally. We aimed to investigate NAFLD-related mortality profiles in hospitalized patients in southern China.Methods: A multicenter retrospective investigation with a 10-year study period (2009–2018) analyzed 10,071 deaths during hospitalization (NAFLD: 2,015; other liver diseases: 1,140; without liver diseases: 6,916) was performed using a multiple cause of death analysis. Medical histories and biochemistry and imaging findings were extracted from the electronic medical record system. The underlying causes of death were classified by 10th Revision of the International Classification of Diseases (ICD-10) codes.Results: The distribution of death causes in patients with NAFLD has stabilized over time, with cardio- and cerebral vascular disease (CVD) ranked first (35.6%), followed by extrahepatic malignancies (22.6%), infection (11.0%), kidney disease (7.5%), liver-related diseases (5.2%), respiratory diseases (3.9%), digestive diseases (3.5%), endocrine diseases (3.5%), and other diseases (7.2%). NAFLD patients had more deaths attributable to CVD, extrahepatic malignancies, liver-related diseases (all P < 0.001) and multiorgan failure than the deceased controls. The severity of steatosis was independently associated with these relationships (liver-related diseases: OR = 1.37, 95% CI: 1.20–1.59, cardio- and cerebrovascular diseases: OR = 1.23, 95% CI: 1.19–1.31, infectious diseases: OR = 1.14, 95% CI: 1.04–1.26, and renal diseases: OR = 1.21, 95% CI: 1.02–1.47, all P < 0.05) after adjustment for sex, body mass index (BMI), fasting blood glucose, low-density lipoprotein cholesterol, uric acid, metabolic syndromes and fibrosis index based on the 4 factors.Conclusion : NAFLD patients had higher proportions of death due to underlying CVD and liver-related diseases than the general population in China; these proportions positively correlated with steatosis degree.
Highlights
Non-alcoholic fatty liver disease (NAFLD) has become the primary cause of chronic liver diseases in the last decade, affecting over one-fourth of the population worldwide [1]
A recent metaanalysis reported that NAFLD increased overall mortality by 57% compared with the general population; mortality was mainly attributable to liver disease and cardiovascular disease (CVD) [17]
Because steatosis can reduce or disappear during advanced fibrosis or cirrhosis development [22,23,24,25], and our study includes NAFLD patients retrospectively from multicenter using ultrasonography to establish diagnosis, part of NAFLD patients would progress to inflammation and fibrosis stage with steatosis degree decreased and they might be misclassified as cryptogenic cirrhosis due to the insufficient sensitivity of ultrasound, cryptogenic cirrhosis would be ascribed to mild NAFLD in the analysis to avoid underestimation in this study
Summary
Non-alcoholic fatty liver disease (NAFLD) has become the primary cause of chronic liver diseases in the last decade, affecting over one-fourth of the population worldwide [1]. NAFLD is strongly associated with and contributes to the clinical burden of such specific complications, whether it contributes to mortality due to distinct liver-related and extrahepatic diseases remains unknown [14,15,16]. A recent metaanalysis reported that NAFLD increased overall mortality by 57% compared with the general population; mortality was mainly attributable to liver disease and CVD [17]. In a more recent longitudinal study with a 10-year follow-up in southern Asia, a lack of an association between NAFLD and cardiovascular mortality was reported [19]. The clinical burden and natural history of non-alcoholic fatty liver disease (NAFLD) vary globally. We aimed to investigate NAFLD-related mortality profiles in hospitalized patients in southern China
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