Department of Medicine and Therapeutics , The Chinese University of Hong Kong , Hong Kong , China.
Medical Data Analytics Centre , The Chinese University of Hong Kong , Hong Kong , China.
Hepatology. 2023 Feb 1;77(2):573-584. doi: 10.1002/hep.32633. Epub 2022 Jul 15.
It is unclear if the leading causes of death in patients with NAFLD differ by age. We aimed to investigate if the relative importance of liver-related deaths is lower and overshadowed by cardiovascular and cancer-related deaths in the elderly population.
We conducted a territory-wide retrospective cohort study of adult patients with NAFLD between 2000 and 2021 in Hong Kong. The outcomes of interest were all-cause and cause-specific mortality. Age groups at death were studied at 10-year intervals. During 662,471 person-years of follow-up of 30,943 patients with NAFLD, there were 2097 deaths. The top three causes of death were pneumonia, extrahepatic cancer, and cardiovascular diseases. Liver disease was the sixth leading cause of death in patients aged 70-79 and 80-89 years, accounting for 5.1% and 5.9% of deaths, respectively, but only accounted for 3% or fewer of the deaths in the other age groups. Nonetheless, liver disease was the leading cause of death in patients with NAFLD-related cirrhosis, accounting for 36.8% of all deaths. The incidence of liver-related death was higher in men younger than age 70 but higher in women afterwards. The incidence of liver-related death in women increased from 0.62 to 7.14 per 10,000 person-years from age 60-69 to 70-79 years.
The relative importance of liver-related death increases with age in patients with NAFLD, especially among women. In patients with cirrhosis, liver disease is the leading cause of death.
非酒精性脂肪性肝病（NAFLD）患者的主要死因是否因年龄而异尚不清楚。我们旨在研究老年人群中，与肝脏相关的死亡相对重要性是否降低并被心血管和癌症相关死亡所掩盖。
我们在香港进行了一项针对 2000 年至 2021 年间成年 NAFLD 患者的全港范围回顾性队列研究。主要结局为全因死亡率和死因特异性死亡率。按死亡时的年龄组以 10 年为间隔进行研究。在 30943 例 NAFLD 患者的 662471 人年随访中，共有 2097 例死亡。前三位死因是肺炎、肝外癌症和心血管疾病。在 70-79 岁和 80-89 岁的患者中，肝脏疾病分别是第六大和第七大死因，占死亡人数的 5.1%和 5.9%，但在其他年龄组中仅占 3%或更少。然而，肝脏疾病是与 NAFLD 相关的肝硬化患者死亡的主要原因，占所有死亡人数的 36.8%。年龄小于 70 岁的男性中肝脏相关死亡的发生率较高，但此后女性的发生率更高。女性的肝脏相关死亡发生率从 60-69 岁到 70-79 岁从 0.62 增加到 7.14/10000 人年。
NAFLD 患者的肝脏相关死亡相对重要性随年龄增长而增加，尤其是女性。在肝硬化患者中，肝脏疾病是主要死因。
