Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis

Background/Aims Non-alcoholic steatohepatitis (NASH) is a growing public health problem. Evaluation of risk factors for fibrosis in NASH will help to target resources to reduce development of cirrhosis. This study had two aims; the first to compile longitudinal histological data to characterize the natural history of fibrosis progression in NASH, and second, to identify predictive factors for progression to advanced fibrosis (stage 3 or greater) in NASH. Methods Subjects had to have a histological diagnosis compatible with NASH on their initial biopsy, received no intervention of proven histological benefit, and undergone two liver biopsies with at least an interval of one year between them. Results Ten studies were selected comprising 221 patients. 37.6% had progressive fibrosis over a mean follow-up interval of 5.3 years (SD, 4.2 years, median, 3.7 years, range 1.0–21.3 years). Proportional hazards regression analysis demonstrated that age (HR = 0.98, p = 0.009) and inflammation on initial biopsy (any inflammation, HR = 2.5, p = 0.001; grade 1, HR = 2.5, p = 0.001; grade 2, HR = 2.4, p = 0.003) are independent predictors of progression to advanced fibrosis. Other traditional parameters (e.g. obesity, diabetes, hypertension) were not statistically significant predictors. Conclusions Presence of inflammation on the initial biopsy and age are independent predictors of progression to advanced fibrosis in patients with NASH.