INCIDENTAL FINDING OF FATTY LIVER IN AUTOPSIES

Abstract

Introduction and Objectives: Non alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD) are the most common emergent causes of chronic liver disease; they evolve from simple steatosis, steatohepatitis, fibrosis/cirrhosis and hepatocellular carcinoma. Knowing the factors that influence their development and screening can improve the prognosis of these patients. Objective: To determine the prevalence of incidental findings of fatty liver in necropsies performed for all causes of mortality and to analyze the main characteristics of these patients. Materials and Methods: Type and design of the study: Observational, descriptive, transversal study. Procedure: All necropsy records for all causes of mortality registered at the Pathology Department in our center in the last 10 years were reviewed (January 2010 – December 2019). We search the following findings: “liver steatosis,” “steatohepatitis,” degree of fibrosis/cirrhosis, “atherosclerosis,” “heavy alcohol intake,” “diabetes, obesity, dyslipidemia, metabolic syndrome.” We used descriptive and analytical statistics: X2, exact Fisher´s test, univariate and multivariate logistic regression models. Results: 4557 necropsies were registered. Fatty liver was found in 6.4% of the cases. 53.3% were women; 51±15 years old; There was simple steatosis in 156 cases (53.6%) and steatohepatitis with necroinflammatory activity in 135 (46.4%). A 49.8% presented liver fibrosis (F1=38 [13.1%]; F2=48 [16.5%]; F3=15 [5.2%]; F4=44 [15.1%]). The etiology through clinical history and histological findings compatible with alcoholic liver injury occurred in 67 cases (23%), NAFLD in 98 (33.7%), mixed type (NAFLD+ALD) in 19 (6.5%), the etiology could not be identified in 107 (36.8%). The multivariate analysis showed alcohol intake as the main risk factor for necroinflammation (OR=2.58; ICal95%= 1.52-4.38; p<0.0001). History of alcohol intake (OR=2.52; ICal95%= 1.40-4.54; p=0.002) and presence of necroinflammatory activity (OR=6.53; ICal95%= 3.72-11.47; p<0.0001) were predictive factors of fibrosis F2-F4. (Table 1) Conclusions: In this study, which included all causes of death, incidental findings of steatosis, steatohepatitis, and fibrosis/cirrhosis were found in a high proportion. Alcohol consumption continues to contribute significantly to liver injury in Mexico.The authors declare that there is no conflict of interest.