Prognostication in NAFLD: physiological bases, clinical indicators, and newer biomarkers
-
Terracciani, Francesca [1] ; Falcomatà, Andrea [1] ; Gallo, Paolo [1] ; Picardi, Antonio [1] ; Vespasiani-Gentilucci, Umberto [1]
-
[1] Hepatology and Clinical Medicine Unit, University Campus Bio-Medico of Rome, Rome, Italy
-
- Localización: Journal of physiology and biochemistry, ISSN-e 1877-8755, ISSN 1138-7548, Vol. 79, Nº. 4, 2023, págs. 851-868
- Idioma: inglés
- Enlaces
-
Resumen
Non-alcoholic fatty liver disease (NAFLD) is becoming an epidemic in Western countries. Notably, while the majority of NAFLD patients will not evolve until advanced liver disease, a minority of them will progress towards liver-related events. Therefore, risk stratifcation and prognostication are emerging as fundamental in order to optimize human and economic resources for the care of these patients. Liver fbrosis has been clearly recognized as the main predictor of poor hepatic and extrahepatic outcomes. However, a prediction based only on the stage of fbrosis is near-sighted and static, as it does not capture the propensity of disease to further progress, the speed of progression and their changes over time. These determinants, which result from the interaction between genetic predisposition and acquired risk factors (obesity, diabetes, etc.), express themselves in disease activity, and can be synthesized by biomarkers of hepatic infammation and fbrogenesis. In this review, we present the currently available clinical tools for risk stratifcation and prognostication in NAFLD specifcally with respect to the risk of progression towards hard hepatic outcomes, i.e., liver-related events and death. We also discuss about the genetic and acquired drivers of disease progression, together with the physiopathological bases of their come into action. Finally, we introduce the most promising biomarkers in the direction of repeatedly assessing disease activity over time, mainly in response to future therapeutic interventions.
