In:
American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S590-S591
Abstract:
Non-alcoholic fatty liver disease (NAFLD) is pandemic across the world and has a wide spectrum of presentations. Both NAFLD and its most severe histopathologic subtype, non-alcoholic steatohepatitis (NASH), can progress to cirrhosis, making early diagnosis pivotal. Liver histology is critical for the diagnosis of NASH, however little is known about the association of social and medical factors with its histologic features. We are conducting a retrospective analysis of a large single center database of over 2000 patients with fatty liver disease proven by biopsy. Here we focus on one year of data collected at our institution. METHODS: We reviewed 653 liver biopsies from a one-year period at Methodist Liver Institute to identify subjects with NAFLD and NASH based on the NAFLD Activity Score (NAS). NASH was defined as NAS score = 〉 3. Patients under the age of 18, documented significant alcohol use, and without steatosis were excluded. We then collected data on demographics (age, race, insurance, and median income), comorbid disease (diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome), and medication use (antihypertensives, oral antihyperglycemics, insulin, statins, opioids), and used univariate statistical analysis to compare subjects with and without NASH. RESULTS: Of 253 biopsies included, 118 had steatosis without NASH and 145 had steatosis with NASH. Subjects with NASH were significantly younger, and more likely to be of Caucasian race than African American race, have Medicaid than commercial insurance, and have diabetes mellitus with use of oral antihyperglycemics. There was no significant difference between NASH and no NASH groups with regards to BMI, hypertension, hyperlipidemia, metabolic syndrome, or use of antihypertensives, statins, insulin, or opioids (Table 1). CONCLUSION: Though histologic confirmation is the gold standard to distinguish NAFLD from NASH, there is a lack of data establishing prognostic factors that may predict the degree of fibrosis. In our analysis having diabetes mellitus or Medicaid instead of commercial insurance correlated with more severe histopathologic disease, suggesting that more aggressive screening and treatment should be promoted in this population. There was no significant difference in socioeconomic factors such as median income or metabolic syndrome. Our study was limited by small size, and data collection is ongoing to determine other factors that may contribute to worsening fibrosis and validate or refute these early findings.
Type of Medium:
Online Resource
ISSN:
0002-9270
,
1572-0241
DOI:
10.14309/01.ajg.0000593660.06344.d5
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
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