Thus, when we have to counsel patients with simple steatosis, it is

safe to state that simple steatosis is not associated with a prognosis worse than expected in individuals of the same age and gender. On the contrary, the overall and liver-related mortality in patients with NASH is higher than expected in individuals PD-1 inhibitor of the same age and gender, but this observation comes from a single study that included only 71 patients with NASH.2 Unfortunately, because there is no consensus on what is the best definition of NASH, different histological criteria have been used in the various studies for defining NASH.2–4, 7 Most recently, the Pathology Subcommittee of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)-sponsored NASH-clinical research network (CRN) has proposed a semiquantitative scoring system to grade and stage the several histological features of NAFLD.11 That scoring system is intended to be used in the design of clinical trials, not to

replace the pathologist’s judgment on the diagnosis of NASH, and it remains uncertain whether the use of this scoring system for NASH classification provides any prognostic information. In this issue of HEPATOLOGY, Soderberg et al.4 report an 80% (standardized mortality ratio click here 1.8, 95% CI 1.48-2.16) increased mortality in 256 patients with elevated liver enzymes who underwent liver biopsy and had a mean follow-up of 21 years. One-hundred and eighteen (46%) patients suffered from NAFLD, and the remaining had liver disease not related to NAFLD. Although the number of patients selleck compound is too small to derive substantial conclusions, particularly for those with liver disease other than NAFLD, the study provides some interesting observations

in the group of patients with NAFLD. First, the NAFLD group had a 70% (standardized mortality ratio 1.7; 95% CI 1.24-2.25) higher risk of dying as compared to a population of similar age and sex, and this increased risk is almost identical to that reported in two large prior studies.1, 2 Second, using the NASH-CRN histology scoring system,11 patients were divided into those with definitive NASH (n = 51) and with no definitive NASH (or non NASH, n = 67); the overall mortality in the group with definitive NASH (but not in the non NASH group) was significantly higher as compared to the general population of the same age and gender, similar to what was reported in a prior study.2 Third, as illustrated in Fig. 2A in the paper, overall mortality was almost identical between the definitive NASH and non NASH groups which also had been reported in another recent long-term follow-up study.3 The study by Soderberg at al.4 essentially reproduces several observations from prior long-term follow-up studies,1–3 but most intriguing is the reported similar overall-related and liver-related mortality between the groups with and without definitive NASH. There are two most likely explanations for the lack of difference in survival between the two groups.