Clinical Impact of Sexual Dimorphism in Non-alcoholic Fatty Liver Disease (NAFLD) and Non-alcoholic Steatohepatitis (NASH)

Patrizia Burra; Debora Bizzaro; Anna Gonta; Sarah Shalaby; Martina Gambato; Maria Cristina Morelli; Silvia Trapani; Annarosa Floreani; Fabio Marra; Maurizia Rossana Brunetto; Gloria Taliani; Erica Villa


Liver International. 2021;41(8):1713-173. 

In This Article

End-stage Liver Disease and Acute-on-chronic Liver Failure

The prevalence of cirrhosis among 492 biopsy-proven NASH patients was higher in women (57%) than in men (43%).[90] In a study on 144 patients with NAFLD, sex was not an independent risk factor for the progression of fibrosis, while, at multivariate analysis, older age (>45 years), obesity, presence of diabetes and AST/ALT ratio>1 were independent significant predictive factors of severe fibrosis.[91]

Acute-on-chronic liver failure (ACLF) is characterized by multiple organ failure with high short-term mortality. Despite ACLF incidence due to NASH is lower when compared to other aetiologies, it is the fastest growing liver disease aetiology among all ACLF hospitalizations, as demonstrated in a recent US population-based study.[92] In this study, the authors detected an exponentially increased frequency of ACLF admissions for NASH aetiology with 12% of NASH-related ACLF in 2006–2008, 33% in 2009–2011 and 55% in 2012–2014. NASH-ACLF patients are more frequently women (60%) and older than in other aetiologies, with a more severe course characterized by higher mortality, more frequent need of dialysis and higher length of stay. Metabolic derangements such as obesity and diabetes might also play a confounding role in the pathophysiology, clinical course and prognosis of NASH patients with ACLF.[93]