Predictors of advanced fibrosis in non-cirrhotic non-alcoholic fatty liver disease in Germany.

Abstract

Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non-alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non-cirrhotic NAFLD is difficult to identify and data from Germany are lacking. To identify clinical factors associated with advanced, non-cirrhotic fibrosis. Patients were recruited in the prospectively enrolling European NAFLD Registry. Clinical characteristics and the performance of non-invasive surrogate scores compared with vibration-controlled transient elastography are reported. Two hundred and sixty-one patients with non-cirrhotic NAFLD on liver biopsy (mean age 51years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50years, P<0.01), had a higher body mass index (32.3 vs 30.5, P<0.05), and more frequent arterial hypertension (78% vs 50%, P=0.001) and type 2 diabetes (61% vs 24.1%, P<0.001). On multivariate logistic regression, diabetes (OR=4.68, 95% CI 2.17-10.10) and hypertension (OR=2.91, 95% CI 1.12-7.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an AUROC of 0.81 (95% CI 0.72-0.91). The performance of NAFLD fibrosis score, Fibrosis-4, and AST to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively. The prevalence of metabolic comorbidities in a German population with non-cirrhotic biopsy-proven NAFLD is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood-based non-invasive surrogate scores in ruling out advanced fibrosis.