INCIDENTAL FINDING OF FATTY LIVER IN AUTOPSIES

Introduction and Objectives

Non alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD) are the most common emergent causes of chronic liver disease; they evolve from simple steatosis, steatohepatitis, fibrosis/cirrhosis and hepatocellular carcinoma. Knowing the factors that influence their development and screening can improve the prognosis of these patients.

Objective

To determine the prevalence of incidental findings of fatty liver in necropsies performed for all causes of mortality and to analyze the main characteristics of these patients.

Materials and Methods

Type and design of the study: Observational, descriptive, transversal study.

Procedure

All necropsy records for all causes of mortality registered at the Pathology Department in our center in the last 10 years were reviewed (January 2010 – December 2019). We search the following findings: “liver steatosis,” “steatohepatitis,” degree of fibrosis/cirrhosis, “atherosclerosis,” “heavy alcohol intake,” “diabetes, obesity, dyslipidemia, metabolic syndrome.” We used descriptive and analytical statistics: X², exact Fisher´s test, univariate and multivariate logistic regression models.

Results

4557 necropsies were registered. Fatty liver was found in 6.4% of the cases. 53.3% were women; 51±15 years old; There was simple steatosis in 156 cases (53.6%) and steatohepatitis with necroinflammatory activity in 135 (46.4%). A 49.8% presented liver fibrosis (F1=38 [13.1%]; F2=48 [16.5%]; F3=15 [5.2%]; F4=44 [15.1%]). The etiology through clinical history and histological findings compatible with alcoholic liver injury occurred in 67 cases (23%), NAFLD in 98 (33.7%), mixed type (NAFLD+ALD) in 19 (6.5%), the etiology could not be identified in 107 (36.8%). The multivariate analysis showed alcohol intake as the main risk factor for necroinflammation (OR=2.58; ICal95%= 1.52-4.38; p<0.0001). History of alcohol intake (OR=2.52; ICal95%= 1.40-4.54; p=0.002) and presence of necroinflammatory activity (OR=6.53; ICal95%= 3.72-11.47; p<0.0001) were predictive factors of fibrosis F2-F4. (Table 1)

Conclusions

In this study, which included all causes of death, incidental findings of steatosis, steatohepatitis, and fibrosis/cirrhosis were found in a high proportion. Alcohol consumption continues to contribute significantly to liver injury in Mexico.

The authors declare that there is no conflict of interest.