Decline in serum albumin concentration is a predictor of serious events in nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome, which includes diabetes mellitus and hyperlipidemia. A fraction of NAFLD patients develop nonalcoholic steatohepatitis, leading to cirrhosis associated with various serious complications, including hepatocellular carcinoma, gastroesophageal varices, cardiovascular events, and other organ malignancy. Although the incidence of chronic viral hepatitis with associated complications has gradually decreased as highly effective antiviral therapies have been established, the number of patients with steatohepatitis has been increasing.This retrospective study examined data of 229 patients from 22 hospitals in our region. We examined 155 cases of chronological data and assessed the development of liver fibrosis and evaluated hepatic reserve-related markers such as platelet count, FIB-4 index, prothrombin time, and serum albumin concentration. We analyzed the relationship of these chronological changes and the incidence of NAFLD related serious complications.Data related to liver fibrosis progression, albumin, and prothrombin time were significantly associated with the occurrence of serious complications associated with cirrhosis. We compared 22 event and 133 nonevent cases of chronological changes in the data per year and found that serum albumin concentration was significantly lower in the group that developed serious complications (event cases: -0.21 g/dL/year, nonevent cases: -0.04 g/dL/year (P < .001)). This albumin decline was only the associated factor with the event incidence by multivariate analysis (P < .01).Annual decline in serum albumin concentration in patients with NAFLD is associated with serious events from the outcome of multicenter retrospective study. This highlights its potential utility as a surrogate marker to assess the efficacy of prediction of NAFLD related serious events.

Figure 1

NAFLD patient data collection from multiple institutions. Most of institution participated in providing patients so that we could analyze changes in data before serious NAFLD-related events. ALT = alanine aminotransferase, NAFLD = nonalcoholic fatty liver disease.

Figure 2

Comparison of changes in laboratory data between NAFLD-related serious event and nonevent cases. (a) Change in serum albumin per year. (b) Changes in FIB-4 index per year. (c) Changes in platelet count per year. (d) Changes in prothrombin time per year. NAFLD = nonalcoholic fatty liver disease.

Figure 3

Serum albumin changes per year between event and nonevent groups. Data in the nonevent group was compared to that in the event group; all events, gastroesophageal varices, hepatic failure, HCC, other cancer events, and cardiovascular events. HCC = Hepatocellular carcinoma.