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Su1044 Is Bariatric Surgery Beneficial in Patients With NAFLD and Advanced Fibrosis?
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at baseline and on follow up compared to the average. . No patients died or required liver transplant.. Of the four patients with stage 4 fibrosis who had a repeat biopsy, 3 still had F4 and one showed regression to F2. Of 4 patients with F3 initially who underwent repeat biopsy, one had F3 and three had no fibrosis. Conclusion: As in patients with less advanced liver disease, bariatric surgery is safe and also leads to improvement in NAFLD patients with advanced fibrosis. Baseline characteristics
AASLD Abstracts
Nonalcoholic Fatty Liver Disease and Cardiovascular Mortality in Older Individuals: A Prospective Cohort Study Suzanne E. Mahady, Germaine Wong, Robin M. Turner, Paul Mitchell, Petra Macaskill, Jonathan Craig, Jacob George Background: Prospective studies of an independent association between non-alcoholic fatty liver disease (NAFLD) and all-cause or cardiovascular mortality have generally not shown a relationship, however most studies are based on a single cohort (NHANES-III) with a young mean age (41 years). Currently, there are no data in other populations including older age groups who have a higher risk of mortality. Aim: To determine the excess risk of all-cause and cardiovascular mortality in older individuals with NAFLD. Methods: We utilized data from the Blue Mountains Eye Study, a prospective population based cohort study of 2335 people aged 50-99 years (mean age 69) with record linkage to a national death registry. Participants were categorized as having NAFLD if their baseline GGT was >51 and ALT >40 IU/ml for males, and GGT >33 and ALT >31 IU/ml for females. Adjusted Cox proportional hazards models assessed the association of NAFLD and all-cause and cardiovascular mortality using both baseline-only measurements of liver enzymes and a repeated measurement during follow up that could allow for a change in NAFLD status. Results: Over a median follow up of 10 years (20,145 person years), 701 people died, including 203 (34%) from cardiovascular disease. Survival models adjusted for sex, age, smoking and alcohol intake indicated that people with NAFLD had an increased risk of allcause mortality that was modified by age (test for interaction p=0.01). Age-stratified analyses demonstrated no increased risk at younger ages (for those aged ≤ 59 years, H.R. 0.46), but increased mortality risk with age (for those aged 60-69, H.R. 1.05, for those aged 70-79 years, H.R. 1.54, and for those ≥ 80 years, H.R. 3.53 ). Similarly, the risk of cardiovascular mortality in people with NAFLD was also modified by age (test for interaction p=0.02). Adjusted age-stratified analyses indicated no increase risk in younger age groups, but increased after 65 years (for those aged 70-79, H.R. 3.15, for those aged ≥ 80, H.R. 6.86). The excess risk of cardiovasuclar mortality was greater than that with all-cause mortality (Figure 1). Analyses using a repeated measurement of liver enzymes to reduce misclassification yielded similar results. Conclusion: In older individuals, NAFLD is associated with an independent, excess risk of all cause and cardiovascular mortality that increases with age.
Figure 1. Risk of all-cause and cardiovascular mortality in people with NAFLD compared to those without NAFLD, according to age at baseline. Su1044 Is Bariatric Surgery Beneficial in Patients With NAFLD and Advanced Fibrosis? Tavankit Singh, Gursimran Kochhar, Philip R. Schauer, Arthur J. McCullough Background: Obesity is a major risk factor for nonalcoholic fatty liver disease (NAFLD), which is the most common chronic liver disease in the US. Bariatric surgery performed for weight loss has been reported to cause regression of liver disease in NALFD patients with minimal fibrosis (stage 0-2). This study investigated whether bariatric surgery is safe and beneficial in NAFLD patients with advanced fibrosis (stage 3-4). Methods: All patients who had undergone bariatric surgery (Roux en Y bypass, sleeve gastrectomy, gastric banding) between 2006-2010 and had evidence of NASH with metavir fibrosis score 3-4 (F3-4) on intra- operative liver biopsy were included and compared to patients with metavir fibrosis score 1-2 after matching them for age, sex and BMI and followed up for 5 years. Data are presented as mean ± standard deviation or N (%). Univariate analysis to compare the groups; analysis of variance (ANOVA) or the non-parametric Kruskal-Wallis tests were used to compare continuous variables and Pearson's chi-square test was used for categorical factors. A p < 0.05 was considered statistically significant. Results: 54 patients with F1-2 (group 1) and 54 patients with F3-4 (group 2) were included. Neither mean age ( 49.5 vs 49.8 years) nor mean BMI ( 47.74 and 47.87 kg/m2) ) differed between groups. Group 2 had a higher proportion of patients with diabetes (88.9% vs 50%) and significantly higher transaminases levels with AST of 47.5 and ALT of 48.6 vs AST (32.8) and ALT (38.2). One year after surgery, AST and ALT levels normalized and remained within the normal range through the follow up period. There was also a significant improvement in BMI in both the groups within 1 year of surgery. Median length of hospital stay after surgery was higher in group 2 (4 days vs 3 days; p-0.048). Proportion of patients developing post- operative complications was similar in both groups (16.6%) but more patients with F3-F4 needed ICU stay (9.2% vs 5.5%; p-0.462). Only 2/55 (3.6%) patients in group 2 went on to develop complications of cirrhosis (one with ascites and one with encephalopathy). Both patients had higher BMIs
AASLD Abstracts
Su1045 The Combined Ck-18 Fragments and Noninvasive Scoring Systems Do Not Perform Better Than Those of Scoring System Alone in Identifying NASH Sombat Treeprasertsuk, Puth Muangpaisarn, Panida Piyachaturawat, Naruemon Wisedopas, Piyawat Komolmitr, Pisit Tangkijvanich Background: Cytokeratins are keratin-containing proteins and comprise the major intermediate filament protein of the liver. Recently, the meta-analysis showed that CK-18 fragment may be used as a biomarker for diagnosing nonalcoholic steatohepatitis (NASH) with a best single cut-off level showed 66% sensitivity and 82% specificity. However, its variability in the suggested cut-offs may limit the generalized use in clinical practice. Objectives: To study the diagnostic test of the combined CK-18 fragments and noninvasive scoring system and noninvasive scoring system alone for diagnosing of NASH. Methods: Noninvasive scoring systems including NAFLD fibrosis score (NFS) and BARD score were used. Cytokeratin-18 (CK-18) fragments levels were measured using the M30-Apoptosense ELISA Kit which represents the hepatocyte apoptosis (U/L). The diagnosis of NAFLD or NASH was graded by NAFLD activity score (NAS, range 0-8). NFS was used to separate NAFLD patients with and without advanced liver fibrosis which the cutoff score at > -1.455 (web base calculation;
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at baseline and on follow up compared to the average. . No patients died or required liver transplant.. Of the four patients with stage 4 fibrosis who had a repeat biopsy, 3 still had F4 and one showed regression to F2. Of 4 patients with F3 initially who underwent repeat biopsy, one had F3 and three had no fibrosis. Conclusion: As in patients with less advanced liver disease, bariatric surgery is safe and also leads to improvement in NAFLD patients with advanced fibrosis. Baseline characteristics
AASLD Abstracts
Nonalcoholic Fatty Liver Disease and Cardiovascular Mortality in Older Individuals: A Prospective Cohort Study Suzanne E. Mahady, Germaine Wong, Robin M. Turner, Paul Mitchell, Petra Macaskill, Jonathan Craig, Jacob George Background: Prospective studies of an independent association between non-alcoholic fatty liver disease (NAFLD) and all-cause or cardiovascular mortality have generally not shown a relationship, however most studies are based on a single cohort (NHANES-III) with a young mean age (41 years). Currently, there are no data in other populations including older age groups who have a higher risk of mortality. Aim: To determine the excess risk of all-cause and cardiovascular mortality in older individuals with NAFLD. Methods: We utilized data from the Blue Mountains Eye Study, a prospective population based cohort study of 2335 people aged 50-99 years (mean age 69) with record linkage to a national death registry. Participants were categorized as having NAFLD if their baseline GGT was >51 and ALT >40 IU/ml for males, and GGT >33 and ALT >31 IU/ml for females. Adjusted Cox proportional hazards models assessed the association of NAFLD and all-cause and cardiovascular mortality using both baseline-only measurements of liver enzymes and a repeated measurement during follow up that could allow for a change in NAFLD status. Results: Over a median follow up of 10 years (20,145 person years), 701 people died, including 203 (34%) from cardiovascular disease. Survival models adjusted for sex, age, smoking and alcohol intake indicated that people with NAFLD had an increased risk of allcause mortality that was modified by age (test for interaction p=0.01). Age-stratified analyses demonstrated no increased risk at younger ages (for those aged ≤ 59 years, H.R. 0.46), but increased mortality risk with age (for those aged 60-69, H.R. 1.05, for those aged 70-79 years, H.R. 1.54, and for those ≥ 80 years, H.R. 3.53 ). Similarly, the risk of cardiovascular mortality in people with NAFLD was also modified by age (test for interaction p=0.02). Adjusted age-stratified analyses indicated no increase risk in younger age groups, but increased after 65 years (for those aged 70-79, H.R. 3.15, for those aged ≥ 80, H.R. 6.86). The excess risk of cardiovasuclar mortality was greater than that with all-cause mortality (Figure 1). Analyses using a repeated measurement of liver enzymes to reduce misclassification yielded similar results. Conclusion: In older individuals, NAFLD is associated with an independent, excess risk of all cause and cardiovascular mortality that increases with age.
Figure 1. Risk of all-cause and cardiovascular mortality in people with NAFLD compared to those without NAFLD, according to age at baseline. Su1044 Is Bariatric Surgery Beneficial in Patients With NAFLD and Advanced Fibrosis? Tavankit Singh, Gursimran Kochhar, Philip R. Schauer, Arthur J. McCullough Background: Obesity is a major risk factor for nonalcoholic fatty liver disease (NAFLD), which is the most common chronic liver disease in the US. Bariatric surgery performed for weight loss has been reported to cause regression of liver disease in NALFD patients with minimal fibrosis (stage 0-2). This study investigated whether bariatric surgery is safe and beneficial in NAFLD patients with advanced fibrosis (stage 3-4). Methods: All patients who had undergone bariatric surgery (Roux en Y bypass, sleeve gastrectomy, gastric banding) between 2006-2010 and had evidence of NASH with metavir fibrosis score 3-4 (F3-4) on intra- operative liver biopsy were included and compared to patients with metavir fibrosis score 1-2 after matching them for age, sex and BMI and followed up for 5 years. Data are presented as mean ± standard deviation or N (%). Univariate analysis to compare the groups; analysis of variance (ANOVA) or the non-parametric Kruskal-Wallis tests were used to compare continuous variables and Pearson's chi-square test was used for categorical factors. A p < 0.05 was considered statistically significant. Results: 54 patients with F1-2 (group 1) and 54 patients with F3-4 (group 2) were included. Neither mean age ( 49.5 vs 49.8 years) nor mean BMI ( 47.74 and 47.87 kg/m2) ) differed between groups. Group 2 had a higher proportion of patients with diabetes (88.9% vs 50%) and significantly higher transaminases levels with AST of 47.5 and ALT of 48.6 vs AST (32.8) and ALT (38.2). One year after surgery, AST and ALT levels normalized and remained within the normal range through the follow up period. There was also a significant improvement in BMI in both the groups within 1 year of surgery. Median length of hospital stay after surgery was higher in group 2 (4 days vs 3 days; p-0.048). Proportion of patients developing post- operative complications was similar in both groups (16.6%) but more patients with F3-F4 needed ICU stay (9.2% vs 5.5%; p-0.462). Only 2/55 (3.6%) patients in group 2 went on to develop complications of cirrhosis (one with ascites and one with encephalopathy). Both patients had higher BMIs
AASLD Abstracts
Su1045 The Combined Ck-18 Fragments and Noninvasive Scoring Systems Do Not Perform Better Than Those of Scoring System Alone in Identifying NASH Sombat Treeprasertsuk, Puth Muangpaisarn, Panida Piyachaturawat, Naruemon Wisedopas, Piyawat Komolmitr, Pisit Tangkijvanich Background: Cytokeratins are keratin-containing proteins and comprise the major intermediate filament protein of the liver. Recently, the meta-analysis showed that CK-18 fragment may be used as a biomarker for diagnosing nonalcoholic steatohepatitis (NASH) with a best single cut-off level showed 66% sensitivity and 82% specificity. However, its variability in the suggested cut-offs may limit the generalized use in clinical practice. Objectives: To study the diagnostic test of the combined CK-18 fragments and noninvasive scoring system and noninvasive scoring system alone for diagnosing of NASH. Methods: Noninvasive scoring systems including NAFLD fibrosis score (NFS) and BARD score were used. Cytokeratin-18 (CK-18) fragments levels were measured using the M30-Apoptosense ELISA Kit which represents the hepatocyte apoptosis (U/L). The diagnosis of NAFLD or NASH was graded by NAFLD activity score (NAS, range 0-8). NFS was used to separate NAFLD patients with and without advanced liver fibrosis which the cutoff score at > -1.455 (web base calculation;
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