P- 62 PREDICTION OF FIBROSIS PROGRESSION AND CLINICAL OUTCOMES WITH NON INVASIVE TESTS IN 10 YEARS FOLLOW UP OF PATIENTS WITH NON ALCOHOLIC STEATOHEPATITIS

Introduction and Objectives

Fibrosis stage is the most important prognostic factor in non-alcoholic fatty liver disease (NAFLD). Although liver biopsy is the gold standard for staging fibrosis, it is a difficult tool to use on follow-up evaluations. Non-invasive tests (NITs) were developed to first stratify patients at risk for advanced fibrosis but were not validated for follow-up. This study aimed to evaluate liver fibrosis progression, NITs variations over time and their correlation with clinical outcomes (hepatic decompensation, hepatic and extra-hepatic neoplasm; cardiovascular events and mortality).

Materials and Methods

Retrospective cohort of 138 patients with biopsy proven non-alcoholic steatohepatitis (NASH). Patients underwent clinical, physical, and laboratory examinations and NIT assessments (FIB-4 and transient elastography - TE). Fibrosis progression was estimated using TE. NIT variations over time were compared with the development of clinical outcomes.

Results

138 patients were analyzed. The median age was 65 years and the median body mass index was 32Kg/m² at diagnosis. Seventy-seven patients (55%) had diabetes and 82 (59%) had hypertension at diagnosis. Fifty-six patients (40%) had advanced fibrosis (≥F3) and 18 (13%) of them had cirrhosis at biopsy. The median time of follow-up was 10 years. One hundred nineteen patients performed TE at the end of the follow-up. Fifty-nine patients progressed to cirrhosis (49,6%). Initial NAFLD activity score (NAS) was statistically associated with fibrosis progression. Twenty-four patients (17%) developed a clinical outcome. The fibrosis stage at diagnosis was associated with cirrhosis decompensation but not associated with cardiovascular events. Fibrosis progression assessed with elastography (>11,5kPa) was associated with portal hypertension development. FIB-4 elevation during follow-up (>2,7) was associated with cirrhosis decompensation.

Conclusions

High-risk NAFLD patients have a high prevalence of fibrosis progression and clinical outcomes. NITs such as FIB-4 and TE might be useful tools for the evaluation of disease progression and risk of hepatic decompensation. More prospective studies are needed to better define NITs cut-offs for risk of clinical outcomes.