{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:36:26Z","timestamp":1790825786678,"version":"4.1.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2017,6,6]],"date-time":"2017-06-06T00:00:00Z","timestamp":1496707200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatology Communications"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD). The minimal pathologic criteria for NASH include hepatic steatosis, ballooning degeneration, and lobular inflammation. The resolution of NASH, which relies on the loss of ballooning degeneration, is subject to sampling and observer variability in pathologic interpretation. Ballooning is associated with advanced hepatic fibrosis in cross\u2010sectional studies but is not a predictor of mortality in NAFLD. Fibrosis staging, while still subject to some sampling variability, has less observer variability and is a robust predictor of liver\u2010related mortality in NAFLD. In this study, we hypothesize that, regardless of the diagnosis of NASH, the presence of steatofibrosis (steatosis accompanied by fibrosis) regardless of other pathologic features can also be a robust predictor of mortality in NAFLD. We used our previously reported cohort of patients with NAFLD with liver biopsies and long\u2010term mortality follow\u2010up. Cox proportional hazard models were used to determine the predictors of overall and liver\u2010related mortality. Of 209 enrolled NAFLD subjects, 97 can be classified as having steatofibrosis. During follow\u2010up (median 150 months), 64 (30.6%) patients died, with 18 (8.6%) from liver\u2010related causes. Adjusted for age, both diagnostic categories of NASH and steatofibrosis were significantly and similarly associated with liver\u2010related mortality (adjusted hazard ratio [aHR], 9.9; 95% confidence interval (CI), 1.3\u201074.9;<jats:italic toggle=\"yes\">P =<\/jats:italic>0.027; aHR, 6.7; 95% CI, 1.5\u201029.8;<jats:italic toggle=\"yes\">P =<\/jats:italic>0.013, respectively). However, only steatofibrosis showed independent association with overall mortality (aHR, 1.76; 95% CI, 1.02\u20103.05;<jats:italic toggle=\"yes\">P =<\/jats:italic>0.043).<jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: Steatofibrosis and NASH are similarly associated with liver\u2010related mortality, but only steatofibrosis is associated with overall mortality in patients with NAFLD. Given the inherent observer variability in ballooning degeneration, a key diagnostic component of NASH, we suggest that steatofibrosis should be considered a viable diagnostic classification for NAFLD subjects at risk or adverse outcomes and provides a simpler endpoint for clinical trials of therapeutic agents. 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Diseases,Washington,DC"},{"name":"Betty and Guy Beatty Center for Integrated Research,Inova Health System,Falls Church,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nila","family":"Rafiq","sequence":"additional","affiliation":[{"name":"Center for Liver Diseases, Department of Medicine,Inova Fairfax Hospital,Falls Church,VA"},{"name":"Betty and Guy Beatty Center for Integrated Research,Inova Health System,Falls Church,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Henry","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research in Liver Diseases,Washington,DC"},{"name":"Betty and Guy Beatty Center for Integrated Research,Inova Health System,Falls Church,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Loomba","sequence":"additional","affiliation":[{"name":"NAFLD Research Center,University of California San Diego,San 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