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Prognosis in Non-alcoholic and Alcoholic
Fatty Liver Patients
- A prospective follow-up study.


Sanne Dam-Larsen  


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Accepted by: Faculty of Health Sciences Copenhagen
Defended on: January 20, 2006
Official opponents: Professor, dr. med. Helmer Ring-Larsen , Professor, dr. med. Morten Grønbæk , Professor, dr. med. Hendrik Vilstrup
Tutors: Dr. med. Flemming Bendtsen , Dr. med. Ulrik Becker

Published in the PhD Database: January 21, 2006


English abstract
The PhD thesis was conducted during my employment at the Gastro-Unit at Hvidovre Hospital, Copenhagen University Hospital. The PhD thesis is a summarized dissertation and includes 2 original articles.

The aim of the study was to examine the risk of development of cirrhosis and mortality in patients without any known chronic liver diseases but with a histological diagnosis of fatty liver without inflammation or fibrosis.

The study was based on historical follow-up, thus allowing follow-up for up to 28 years. Data were obtained from medical records, The Causes of Death Registry and The National Patient Registry of Patients and at the clinical follow-up.

We observed that patients with non-alcoholic fatty liver without inflammation had a low risk of developing cirrhosis and had the same life expectancy as the general population. Survival in NAFLD type 1 patients was for both genders independent of the histological characteristics in the index liver biopsy, while patients with pure alcoholic fatty liver had significantly excess mortality and the severity of steatosis had prognostic information.

Two non-alcoholic patients (1.2%) developed cirrhosis versus 54 alcoholic patients (22%) during the follow-up period.

Albumin at the time of the index liver biopsy was the only biochemical parameter in both groups of patients which in Cox analysis had significant influence on time to death and for the alcoholic group also on time to cirrhosis. For alcoholic patients time to cirrhosis was significantly associated with being of the female sex while histological parameters and alcohol intake at the time of the index liver biopsy had no prognostic influence on time to cirrhosis. No association between BMI at the time of the index liver biopsy and mortality in NAFLD type 1 patients could be demonstrated.




Danish abstract
Ph.d.-projektet fandt sted ved på Hvidovre Hospital ved Gastroenhedens medicinske sektion og udgår fra Københavns Universitet. Afhandlingen er baseret på to originalartikler.

Formålet med ph.d.-studiet var at undersøge risikoen for udvikling af cirrose og død hos patienter, der havde biopsiverificeret steatosis hepatis uden inflammation og fibrose og uden samtidig tilstedeværelse af kendte kroniske leverlidelser.

Studiet var baseret på historisk follow-up på op til 28 år på data fra journaler, Landspatient - og Dødsårsagsregisteret, samt indkaldelse og klinisk undersøgelse.

Undersøgelsen viste, at patienter med non-alkoholisk steatosis hepatis uden inflammation (NAFLD type 1) havde en meget lille risiko for udvikling af cirrose, og overlevelsen var den samme som hos baggrundsbefolkningen. Overlevelsen var for begge køn uafhængig af graden og typen af steatosen i indexleverbiopsien.

Patienter med alkoholisk steatosis hepatis havde signifikant overdødelighed i forhold til normalbefolkning og graden af steatosen havde prognostisk betydning.

I alkohol kohorten udviklede 22% cirrose i follow-up perioden, medens kun 1,2% i non-alkohol kohorten.

Albumin ved indgang i studiet var for begge kohorter eneste biokemiske variabel, som i Cox-analyser viste signifikant sammenhæng med tid til død, og for alkohol kohorten også tid til cirrose. I alkohol kohorten var tid til cirrose signifikant forøget hos kvinder, medens histologiske parametre og alkoholforbrug ved indgang i studiet ikke havde prognostisk betydning. Vi fandt ingen sammenhæng mellem BMI og overlevelse hos NAFLD type 1 patienter.