Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis: A longitudinal study of 1893 biopsy?proven nonalcoholic fatty liver disease subjects

Background and Aim Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of leading causes screening failure in clinical trials. We assessed NASH distribution its components across fibrosis stages their impact on prognosis relationship with concept metabolic-associated fatty liver disease (MAFLD). Methods Spanish multicenter study including 1893 biopsy-proven (NAFLD) patients from HEPAmet registry. was diagnosed by NAS ?4 (including steatosis, ballooning lobular inflammation) Kleiner score. The presence MAFLD determined. Progression to cirrhosis, first episode decompensated cirrhosis death were collected during follow-up (4.7 ± 3.8 years). Results Fibrosis F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) F4 7.2% (137/1893). diagnosis 51.9% (982/1893), individual (severe inflammation), increased (33.6%) (68.6%), decreased significantly (51.8%) (P = .0001). More than 70% non-NASH showed some inflammatory activity (ballooning or showing a similar rate (96.2% [945/982] vs. 95.2% [535/562]) higher (NAFL) subjects (89.1% [311/349]) < between (9.5% [51/539]) indeterminate (7.9% [25/316]), steatosis (5% [14/263]) (logRank 8.417; P .015). Death these. Conclusions prevalence advanced disease. However, most these histologically had metabolic disturbances. These findings should be considered trials whose main aim prevent progression complications, transplant death.