Pennisi, Grazia; Enea, Marco; Viganò, Mauro; Schepis, Filippo; de Ledinghen, Victor; Berzigotti, Annalisa; Wai-Sun Wong, Vincent; Fracanzani, Anna Ludovica; Sebastiani, Giada; Lara-Romero, Carmen; Bugianesi, Elisabetta; Svegliati-Baroni, Gianluca; Marra, Fabio; Aghemo, Alessio; Valenti, Luca; Calvaruso, Vincenza; Colecchia, Antonio; Di Maria, Gabriele; La Mantia, Claudia; Lin, Huapeng; ... (2023). Oesophageal varices predict complications in compensated advanced non-alcoholic fatty liver disease. JHEP reports, 5(9), p. 100809. Elsevier 10.1016/j.jhepr.2023.100809
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BACKGROUND & AIMS
We aimed to evaluate the impact of oesophageal varices (OV) and their evolution on the risk of complications of compensated advanced chronic liver disease (cACLD) caused by non-alcoholic fatty liver disease (NAFLD). We also assessed the accuracy of non-invasive scores for predicting the development of complications and for identifying patients at low risk of high-risk OV.
METHODS
We performed a retrospective assessment of 629 patients with NAFLD-related cACLD who had baseline and follow-up oesophagogastroduodenoscopy and clinical follow-up to record decompensation, portal vein thrombosis (PVT), and hepatocellular carcinoma.
RESULTS
Small and large OV were observed at baseline in 30 and 15.9% of patients, respectively. The 4-year incidence of OV from absence at baseline, and that of progression from small to large OV were 16.3 and 22.4%, respectively. Diabetes and a ≥5% increase in BMI were associated with OV progression. Multivariate Cox regression revealed that small (hazard ratio [HR] 2.24, 95% CI 1.47-3.41) and large (HR 3.86, 95% CI 2.34-6.39) OV were independently associated with decompensation. When considering OV status and trajectories, small (HR 2.65, 95% CI 1.39-5.05) and large (HR 4.90, 95% CI 2.49-9.63) OV at baseline and/or follow-up were independently associated with decompensation compared with the absence of OV at baseline and/or follow-up. The presence of either small (HR 2.8, 95% CI 1.16-6.74) or large (HR 5.29, 95% CI 1.96-14.2) OV was also independently associated with incident PVT.
CONCLUSION
In NAFLD-related cACLD, the presence, severity, and evolution of OV stratify the risk of developing decompensation and PVT.
IMPACT AND IMPLICATIONS
Portal hypertension is the main driver of liver decompensation in chronic liver diseases, and its non-invasive markers can help risk prediction. The presence, severity, and progression of oesophageal varices stratify the risk of complications of non-alcoholic fatty liver disease. Easily obtainable laboratory values and liver stiffness measurement can identify patients at low risk for whom endoscopy may be withheld, and can also stratify the risk of liver-related complications.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine |
UniBE Contributor: |
Berzigotti, Annalisa, Mendoza Jaimes, Yuly Paulin |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2589-5559 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
07 Aug 2023 09:23 |
Last Modified: |
20 Aug 2023 02:37 |
Publisher DOI: |
10.1016/j.jhepr.2023.100809 |
PubMed ID: |
37538247 |
Uncontrolled Keywords: |
NAFLD Portal Vein Thrombosis baveno cACLD liver decompensation liver stiffness varices |
BORIS DOI: |
10.48350/185226 |
URI: |
https://boris.unibe.ch/id/eprint/185226 |
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