Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis

作者：Ali Aminian, Abbas Al‐Kurd, Rickesha L. Wilson, James Bena, Hana Fayazzadeh, Tavankit Singh, Vance L. Albaugh, Faiz U. Shariff, Noe A. Rodriguez, Jian Jin, Stacy A. Brethauer, Srinivasan Dasarathy, Naim Alkhouri, Philip R. Schauer, Arthur J. McCullough, Steven E. Nissen · 发表于：JAMA · 年份：2021 · DOI：10.1001/jama.2021.19569 · 被引用次数：367 · 研究领域：Liver Disease Diagnosis and Treatment、Bariatric Surgery and Outcomes、Diabetes, Cardiovascular Risks, and Lipoproteins

IMPORTANCE: No therapy has been shown to reduce the risk of serious adverse outcomes in patients with nonalcoholic steatohepatitis (NASH). OBJECTIVE: To investigate the long-term relationship between bariatric surgery and incident major adverse liver outcomes and major adverse cardiovascular events (MACE) in patients with obesity and biopsy-proven fibrotic NASH without cirrhosis. DESIGN, SETTING, AND PARTICIPANTS: In the SPLENDOR (Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk) study, of 25 828 liver biopsies performed at a US health system between 2004 and 2016, 1158 adult patients with obesity were identified who fulfilled enrollment criteria, including confirmed histological diagnosis of NASH and presence of liver fibrosis (histological stages 1-3). Baseline clinical characteristics, histological disease activity, and fibrosis stage of patients who underwent simultaneous liver biopsy at the time of bariatric surgery were balanced with a nonsurgical control group using overlap weighting methods. Follow-up ended in March 2021. EXPOSURES: Bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy) vs nonsurgical care. MAIN OUTCOMES AND MEASURES: The primary outcomes were the incidence of major adverse liver outcomes (progression to clinical or histological cirrhosis, development of hepatocellular carcinoma, liver transplantation, or liver-related mortality) and MACE (a composite of coronary artery events, cerebrovascular events, heart fa...