Figure 1. The most dangerous symptoms of cirrhosis. Cirrhosis is a condition where the liver becomes scarred over and dysfunctional. Because the liver is involved so many essential functions of life, cirrhosis has wide ranging symptoms around the body. Cirrhosis can cause fatigue, loss of appetite, brusing, jaundice, bloating, and swelling among other symptoms.
There is no question that late stage NASH can be very dangerous. One of the most common outcomes in late stage NASH Is liver failure.
Patients reach this stage once they become cirrhotic, which is a condition where the liver accumulated so much scar tissue that it can no longer function normally.
This condition leads to a wide variety of striking symptoms across the body. The feet and the belly can swell up like balloons as fluid accumulates. The skin can become yellow and itchy as bilirubin, a waste product, builds up in the blood stream. Patients may also experience a lot more bruising and bleeding as they lose the ability to form clots.
Figure 2. The liver is involved in a wide range of essential functions. It creates compounds essential for the transportation of goods and waste around the body. It synthesizes essential compounds and molecules. It detoxifies and processes chemical wastes that would otherwise build-up in the blood stream. It stores energy in the form of glycogen. It recycles and disposes of waste from proteins and blood cells.
A brief look at the many functions of the liver shows us why cirrhosis can be so dangerous. The liver is one of the most important organs of the body. It performs many essential functions across multiple systems. If it fails, no other organ can take it's place.
With late stage cirrhosis, patients often need liver transplants to stay alive as there are no other machines or treatments that can take the place of a failing liver.
Figure 3. The dangers of NASH are dependent on stage. The risk of mortality in NAFLD depends highly on whether a patient has fibrosis. For patients with fibrosis, the level of fibrosis plays a significant role. Patients with the highest level of fibrosis had nearly all passed away or needed a transplant by the end of the 10 year study period, while 80% of patients with low fibrosis had survived.
Not all patients reach the final cirrhosis stage. In fact, most patients with fatty liver may not even know that they have it.
The risk of mortality and of requiring a liver transplant in NASH depend highly on how much fibrosis a patient has. Fibrosis, in this case, refers to the amount of scar tissue in the liver.
Similar to when the skin has a scar, the liver can grow tough scars over time. These scars, which we call fibrosis, can get in the way of normal liver function.
In a study of 458 patients with NAFLD and fibrosis, researchers found that the survival odds of patients depended highly on how much fibrosis they have. Those with little fibrosis nearly all survived the 10 years of the study without needing a transplant.
Meanwhile, over 80% of those with at least moderate fibrosis and early signs of cirrhosis either passed away or needed a liver transplant.
The odds of transplant-free survival in NASH depends on the level of fibrosis in the liver. In a study of 458 patients with some fibrosis and NASH, around 95% had survived the 10 years of the study. Meanwhile, only 17% of those with some signs of cirrhosis managed to survive the 10 years of the study without needing a transplant.
Figure 5: Reversal of NASH. A small prospective cohort study showed that weight loss was associated with a significantly higher rate of NASH resolution. Among the 19 patients who had lost more than 10% of their body weight over the 4.6 years of the study, 12 patients had achieved fibrosis regression, where their fibrosis begins to go away. Among the 22 patients who did not reach this level of weight loss, only 2 achieved fibrosis regression. This was highly significant with an adjusted OR of 8.14 and a p-value of less than 0.001.
Fortunately, while NASH can be quite dangerous, it is reversible. We're still in the early stages of NASH research, but already several studies have shown promising results.
Just by losing weight, patients in one small study were able to achieve fibrosis regression. As shown above, fibrosis is the most dangerous symptom of NASH and is the symptom most correlated with mortality.
These patients show us that it is indeed possible to reverse some of the dangers of NASH with simple lifestyle changes.
