A cholestatic pattern predicts major liver‐related outcomes in patients with non‐alcoholic fatty liver disease

摘要

Abstract Background & Aims NAFLD patients usually have an increase in AST/ALT levels, but cholestasis can also be observed. We aimed to assess in subjects with NAFLD the impact of the (cholestatic) C pattern on the likelihood of developing major liver‐related outcomes (MALO). Methods Five hundred and eighty‐two consecutive patients with biopsy‐proven NAFLD or a clinical diagnosis of NAFLD‐related compensated cirrhosis were classified as hepatocellular (H), C and mixed (M) patterns, by using the formula (ALT/ALT Upper Limit of Normal‐ULN)/(ALP/ALP ULN). MALO were recorded during follow‐up. An external cohort of 1281 biopsy‐proven NAFLD patients was enrolled as validation set. Results H, M and C patterns were found in 153 (26.3%), 272 (46.7%) and 157 (27%) patients respectively. During a median follow‐up of 78?months, only 1 (0.6%) patient with H pattern experienced MALO, whilst 15 (5.5%) and 38 (24.2%) patients in M and C groups had MALO. At multivariate Cox regression analysis, age >55?years (HR 2.55, 95% CI 1.17–5.54; p?=?.01), platelets <150?000/mmc (HR 0.14, 95% CI 0.06–0.32; p?