Long-term, clinical follow-up in fatty liver patients

The risk of progression to cirrhosis and death in patients with pure alcoholic (AFLD) and non-alcoholic steatosis (NAFLD) has only sparsely been studied. The aims of the present long-term follow-up study were to analyze for risks of progression to cirrhosis and death in a cohort of patients with histologically verified 'pure fatty liver'. 247 patients with biopsy verified AFLD and 170 patients with NAFLD without inflammation were included in the period from 1978 to 1987. Patients in the study cohort were linked through their personal identification number to The National Patient Registry (LPR) and The Causes of Death Registry. All admissions, discharge diagnoses, and causes of death were obtained from January 1, 1977 until death (2004) or December 31, 1999 in the registries. Surviving patients were offered a clinical follow-up in 2004. Survival was observed to be significantly higher (p < 0.01) in NAFLD for men as well as for women, which was not different from the Danish age- and gender-matched population. Two (1.2%) patients with NAFLD developed cirrhosis, while 54 patients (21.9%) with AFLD developed cirrhosis. The degree of steatosis was the only histological parameter significantly associated with premature death in AFLD, but not in NAFLD patients. Risk of progression to cirrhosis and time to development was significantly associated to being of female gender. In conclusion, for patients with NAFLD, survival was good, while patients with AFLD had excess in mortality and risk of development of cirrhosis, which was associated with the degree of steatosis in the index biopsy and being of female gender.