Diabetes Is an Independent Predictor of Advanced Liver Disease

Type 2 diabetes is an independent predictor of advanced liver disease, according to the results of a recent study.

Because of the common nature of non-alcoholic fatty liver disease (NAFLD) and the chance of progression to non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC), researchers sought to estimate the risk of acquiring advanced liver disease and identify potential predictors of disease progression.

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They conducted a study using data from 4 European primary care databases including 18,782,281 adults, 136,703 of whom with recorded diagnoses of NAFLD or NASH. Those patients with NAFLD or NASH were matched with up to 100 “non-NAFLD” patients by site, gender, age ± 5 years, visit recorded within ± 6 months.

The researchers found that those with NAFLD/NASH were more likely to have diabetes, hypertension, and obesity than controls. Hazard ratios (HRs) were 4.73 for cirrhosis and 3.51 for HCC in these patients, compared with controls. HRs for either outcome were higher in those patients with NASH and those with high-risk Fibrosis-4 scores. Overall, the strongest independent predictor of HCC or cirrhosis was a baseline diagnosis of diabetes.

“Real-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasizing the need to identify specific groups of patients at highest risk,” the researchers concluded.

—Michael Potts

Reference:

Alexander M, Loomis AK, van der Lei J, et al. 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 [published online May 20, 2019]. BMC Medicine. https://doi.org/10.1186/s12916-019-1321-x.