How risky is diagnosed NAFLD for cirrhosis and liver cancer?
In ~19 million European adults, coded NAFLD/NASH carried ~4.7× cirrhosis and ~3.5× HCC hazard vs matched controls, with diabetes the strongest predictor.
Source
Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts
Study at a glance
- Design
- Cohort — Matched cohort in four European primary-care databases; Cox HRs pooled by meta-analysis
- N
- N=136703 · 136,703 coded NAFLD/NASH within 18,782,281 adults
- Population
- Adults with coded NAFLD/NASH vs matched non-NAFLD controls in UK/NL/Italy/Spain
- Outcome
- Incident cirrhosis and HCC diagnoses; predictors including diabetes
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How risky is diagnosed NAFLD for cirrhosis and liver cancer?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
136,703 NAFLD/NASH among 18,782,281 adults.
Out of 18,782,281 adults, we identified 136,703 patients with coded NAFLD/NASH.
Cirrhosis HR 4.73; HCC HR 3.51.
HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43–9.19) and for HCC, 3.51 (95% CI 1.72–7.16).
What they did
They identified NAFLD/NASH diagnoses in four primary-care databases, matched each case to up to 100 controls, and pooled age/smoking-adjusted Cox HRs for cirrhosis and HCC.
What they found
Among 136,703 NAFLD/NASH patients, cirrhosis HR 4.73 and HCC HR 3.51 vs controls; risk higher with NASH or high-risk Fib-4; diabetes strongly predicted advanced liver diagnoses.
The limits
What it doesn't show
Coded diagnoses under-ascertain NAFLD; observational HRs are not biopsy-proven natural history or treatment effects.
Key terms
- NAFLD
- Non-alcoholic fatty liver disease.
- NASH
- Non-alcoholic steatohepatitis, a more inflammatory NAFLD phenotype.
- Cirrhosis
- Advanced scarring of the liver.
- HCC
- Hepatocellular carcinoma (primary liver cancer).
- Hazard ratio
- Relative instantaneous event rate vs a reference group.
- Fib-4
- Noninvasive fibrosis score used to stratify liver risk.
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NAFLD/NASH case count:
Common questions
How large was the source population?
18,782,281 adults; 136,703 with coded NAFLD/NASH.
Cirrhosis HR?
4.73 (95% CI 2.43–9.19).
HCC HR?
3.51 (95% CI 1.72–7.16).
Top predictor?
Baseline diabetes diagnosis.
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