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World J Hepatol. Jul 27, 2026; 18(7): 121661
Published online Jul 27, 2026. doi: 10.4254/wjh.121661
Clinicopathological characteristics and risk factors in nonalcoholic steatohepatitis patients with different stages of liver fibrosis
Peng-Yu Pan, Wen-Wen Zheng, Yuan-Qiang Guo, Yong-Gang Liu, Xiao-Jiang Zhang, Ya-Yi Wu, Jian-Zhou Li, Jun-Guo Qi, Chun-Yan Wang
Peng-Yu Pan, Wen-Wen Zheng, Xiao-Jiang Zhang, Ya-Yi Wu, Graduate School, Tianjin Medical University, Tianjin 300070, China
Yuan-Qiang Guo, State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300350, China
Yong-Gang Liu, Department of Pathology, Tianjin Second People’s Hospital, Tianjin 300110, China
Jian-Zhou Li, Jun-Guo Qi, Department of Gastroenterology, Xining Second People’s Hospital, Xining 810003, Qinghai Province, China
Chun-Yan Wang, Department of Gastroenterology, Tianjin Second People’s Hospital, Tianjin Institute of Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin 300110, China
Author contributions: Pan PY and Zheng WW wrote the manuscript; Pan PY, Zhang XJ and Wu YY contributed to data collation; Pan PY and Zhang XJ contributed to statistical analysis; Liu YG contributed to liver pathology reading; Wang CY, Qi JG and Li JZ contributed to manuscript revision; Wang CY and Guo YQ contributed to research supervision; Wang CY contributed to project design; and all authors have read and approve the final manuscript.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Supported by the Tianjin Municipal Health Commission, No. [KY0170].
Institutional review board statement: The study was approved by the Ethics Committee of the Second People’s Hospital of Tianjin, Ethics Approval Number:[2026]11.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment via written consent.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Chun-Yan Wang, MD, Department of Gastroenterology, Tianjin Second People’s Hospital, Tianjin Institute of Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, No. 7 Sudi South Road, Tianjin 300110, China.
wangchunyan123@tmu.edu.cn
Received: March 30, 2026
Revised: June 2, 2026
Accepted: June 24, 2026
Published online: July 27, 2026
Processing time: 116 Days and 23 Hours
BACKGROUND
Nonalcoholic steatohepatitis (NASH) has become the leading chronic liver disease worldwide. Within its spectrum, liver fibrosis is the only histological feature independently linked to long-term mortality and liver-related events. While traditional risk factors such as obesity and diabetes are known, most existing studies rely on noninvasive markers rather than the gold standard for liver biopsy. This study included 122 patients with NASH diagnosed by biopsy to analyze their clinicopathological features and risk factors for fibrosis severity based on the stratification of liver fibrosis.
AIM
To investigate the clinicopathological features and risk factors for fibrosis severity in NASH patients based on pathological stratification.
METHODS
A total of 122 patients with biopsy-proven NASH at Tianjin Second People’s Hospital between December 2014 and December 2024 were included, with their clinical, laboratory, and pathological data collected. Patients were stratified according to the degree of pathological fibrosis. Univariate analysis, ordinal logistic regression, kappa statistic, and receiver operating characteristic (ROC) curves were applied to analyze their clinicopathological features and identify independent risk factors for fibrosis severity.
RESULTS
(1) Twenty-one patients (17.2%) were in the F1 stage, 86 (70.5%) were in the F2 stage, and 15 (12.3%) were in the F3 stage; (2) liver pathology revealed that as fibrosis severity advanced, hepatocellular steatosis and lobular inflammation worsened, with statistically significant differences (P < 0.05); (3) the overall agreement rate between the liver stiffness measurement (LSM) assessment and pathological staging of liver fibrosis was 48.4%; (4) ROC curve analysis revealed that the area under the curve values for the LSM in the diagnosis of stage F2 and F3 liver fibrosis were 0.761 and 0.829, respectively; and (5) ordinal logistic regression revealed that diabetes [odds ratio (OR) = 3.76, 95% confidence intervals (95%CI): 1.30-10.84, P = 0.014] and low-density lipoprotein (LDL) levels (OR = 1.52, 95%CI: 1.10-2.34, P = 0.049) were independent risk factors for liver fibrosis severity in patients with NASH.
CONCLUSION
Diabetes and LDL levels are independent risk factors associated with the severity of liver fibrosis in patients with NASH.
Core Tip: This retrospective study included 122 patients diagnosed with nonalcoholic steatohepatitis (NASH) via liver biopsy. SPSS 27.0 and R 4.5.2 software was used to analyze patient data. Patients were stratified according to the degree of pathological fibrosis, their clinicopathological features were analyzed, and risk factors associated with the severity of liver fibrosis were further explored. We revealed that the presence of diabetes and elevated low-density lipoprotein levels are risk factors associated with the severity of liver fibrosis in patients with NASH.
