Impact of fibrosis on liver-related event incidence in non-alcoholic fatty liver disease: A multicenter observational study

There are few reports on the prognosis of liver-related events in Japanese patients with nonalcoholic fatty liver disease (NAFLD). We conducted an observational study to compare the prognosis between fibrotic and non-fibrotic groups in Japanese NAFLD patients. Prognosis in 393 NAFLD patients who underwent liver biopsy between April 2013 and April 2015 at multiple centers were investigated. The time to onset of liver-related events, cardiovascular events, development of extrahepatic cancers, and death were compared between pathologically fibrotic non-alcoholic steatohepatitis (NASH) group and non-alcoholic fatty liver (NAFL) + non-fibrotic NASH group. Similar analysis was performed based on the fibrotic classification diagnosed using four non-invasive fibrosis prediction models. The mean age and Body Mass Index (BMI) at the time of liver biopsy was 55.7 years old and 28.04 kg/m . The cumulative incidence of liver-related events at 1080 days after liver biopsy was 5.79% in pathologically fibrotic NASH group and 0% in NAFL + non-fibrotic NASH group, with a significant difference (p = 0.0334). The cumulative incidence of liver-related events was significantly higher in the positive group for the prediction model than in the negative group in all four models (all p-values were