aHR, adjusted hazard ratio; CI, confidence interval; HR, hazard ratio; ICD-9, International Classification of Diseases, 9th revision; ICD-10, International Classification of Diseases, 10th revision; LRM, liver-related mortality; NAFLD, nonalcoholic fatty liver disease; NAS, nonalcoholic

fatty liver disease activity score; NASH, nonalcoholic steatohepatitis. Patients with histologically proven NAFLD, available liver biopsy slides, and adequate clinical information were selected from our fatty liver databases. This NAFLD cohort included patients with available clinical data and liver biopsy slides from the Armed Forces Institute of Pathology (Washington DC) as well as the original NAFLD patients whom we previously reported.6 For each patient,

clinical selleck chemical http://www.selleckchem.com/products/Dasatinib.html and demographic data were available (age, sex, race, height, weight, alcohol consumption, medications, presence of diabetes, presence of hyperlipidemia, and results of laboratory tests measuring liver enzymes). The height and the weight were used to calculate the body mass index. To be included in the study, a patient had to have been diagnosed with biopsy-proven NAFLD with a minimum of 5 years of follow-up. Patients were excluded for the following reasons: (1) a daily alcohol intake greater than 20 g in men and greater than 10 g in women; (2) another form of chronic liver disease such as viral hepatitis, autoimmune hepatitis, or medication-induced liver disease; (3) the use of medications associated with fatty liver disease; (4) bariatric surgery or small bowel resection; (5) total parenteral nutrition; and (6) an active or recent malignancy. The study was approved by the institutional

review boards of Inova Health System and the Armed Forces Institute of Pathology. For the purpose of this this website study, all liver biopsy slides were reread at the same time by two hepatopathologists (Z.G. and H.M.) who were blinded to the clinical data. For each liver biopsy, slides stained with hematoxylin-eosin and Masson’s trichrome were reviewed in conference by both hepatopathologists (Z.G. and H.M.), and decisions about each pathologic feature and the diagnosis of NASH were made by consensus. Steatosis was scored as an estimate of the percentage of parenchyma replaced by fat: (0) 0%, (1) up to 5%, (2) 6% to 33%, (3) 34% to 66%, or (4) more than 66%. Lobular inflammation, portal inflammation, hepatocellular ballooning, pericellular/perisinusoidal fibrosis, and portal fibrosis were graded on a scale of 0 to 3: (0) none, (1) mild or few, (2) moderate, or (3) marked or many. Bridging fibrosis was scored as (0) none, (1) few bridges, or (2) many bridges. Cirrhosis was scored as (0) absent, (1) incomplete, or (2) established. Four pathologic protocols or sets of criteria were used to assess each liver biopsy sample.