Objective: Prevalence of NAFLD/NASH is high in DM patients. Presence of DM has been suggested to potentially accelerate liver disease progression among these patients. The study aimed to assess the adverse events among NAFLD/NASH patients with AF (F3 and compensated cirrhosis/F4) stratified by DM status.

Methods: Adult NAFLD/NASH-AF patients with available lab results were identified from Optum Research claims data (2008-2016), to calculate their Fibrosis-4 (FIB-4) scores. Using the score, patients were categorized as F3 or F4 (first date of cut-off score as index date), and then stratified by DM. Events were measured as first date of FIB-4 score/diagnosis consistent with F4, or presence of decompensated cirrhosis (DCC) after initial diagnosis of NAFLD/NASH with F3 or F4.

Results: Among 91,122 NAFLD/NASH patients with FIB-4 scores, 2,482 (2.7%) had F3 and 939 (1.0%) had F4 stage of fibrosis. 36% of F3 and 35% of F4 patients had DM. Overall, incident event rates for patients with NAFLD/NASH - F3 and F4 with DM were higher than those without DM (Figure). Incident DCC rates were also higher in NAFLD/NASH with DM [F3 (33.9%) (p=0.19) and F4 (70.1%) (p=0.04)] than without DM.

Conclusions: NAFLD/NASH patients with AF and DM have higher rates of adverse events. These patients must be identified early for close monitoring and management.


Z. Younossi: Consultant; Self; Gilead Sciences, Inc. N. Kachru: Employee; Self; Gilead Sciences, Inc. Stock/Shareholder; Self; Gilead Sciences, Inc. S. Shreay: Employee; Self; Gilead Sciences, Inc. Stock/Shareholder; Self; Gilead Sciences, Inc. R. Loomba: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc.

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