Fatty liver disease is common in the United States and worldwide due to changing lifestyles and can progress to fibrosis and cirrhosis contributing to premature death.
Drs Aynur Unalp-Arida and Constance Ruhl from Maryland examined whether liver fibrosis scores were associated with increased overall and disease-specific mortality in a United States population–based prospective survey with up to 23 years of linked-mortality data.
The researchers analyzed data from 14,841 viral hepatitis–negative adult participants in the third National Health and Nutrition Examination Survey, 1988-1994.
Liver fibrosis was predicted using the aspartate aminotransferase–to-platelet ratio index (APRI), fibrosis-4 (FIB-4) score, nonalcoholic fatty liver disease fibrosis score (NFS), and Forns score.
The team passively followed participants for mortality, identified by death certificate underlying or contributing causes, by linkage to National Death Index records through 2011.
|Cumulative mortality was 28% from all causes|
Hazard ratios for mortality were calculated using Cox proportional hazards regression to adjust for mortality risk factors.
During follow-up, cumulative mortality was 28% from all causes and less than 1% with liver disease, including primary liver cancer.
Elevated liver disease mortality was found with an intermediate to high APRI, intermediate or high FIB-4 score, high NFS, and intermediate or high Forns score.
The researchers found that overall mortality was also greater with higher fibrosis scores.
Dr Unalp-Arida's team comments, "In the United States population, higher liver fibrosis scores were associated with increased liver disease and overall mortality."
"Liver health management with common clinical measures of fibrosis risk stratification merits further investigation."