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Abstract Details
Surrogate scores of advanced fibrosis in NAFLD/NASH do not predict mortality in patients with medium-to-high cardiovascular risk
Am J Physiol Gastrointest Liver Physiol. 2021 Jun 16. doi: 10.1152/ajpgi.00058.2021.Online ahead of print.
Graciela E Delgado1, Marcus E Kleber12, Angela P Moissl134, Babak Yazdani1, Alexander Kusnik56, Matthias P Ebert56, Winfried März17, Bernhard K Krämer16, Alexander Lammert18, Andreas Teufel56
Author information
1Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
3Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany.
4Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle12 Jena-Leipzig, Germany.
5Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
6Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
7Synlab Academy, SYNLAB Holding Deutschland GmbH, Mannheim and Augsburg, Germany.
8Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany.
Abstract
Background: Untreated NAFLD may have significant consequences including an increase in mortality and cardiovascular injury. Thus, early detection of NAFLD is currently believed not only to prevent liver related but also cardiovascular mortality. However, almost nothing is known about co-existing NAFLD in patients with coronary artery disease (CAD).
Aims: We investigated the impact of surrogates scores of fibrosis in NAFLD in a large cohort of patients referred to coronary angiography.
Results: Modelling the common NALFD and fibrosis scores FIB-4 and NFS as splines revealed significant associations with all-cause and cardiovascular mortality when Cox regression models were only adjusted for cardiovascular risk factors that were not already included in the calculation of the scores. Stratifying the scores into quartiles yielded hazard ratios (95% CI) for all-cause and cardiovascular mortality for the 4th quartile vs the 1st quartile of 2.28 (1.90-2.75) and 2.11 (1.67-2.67) for FIB-4 and of 3.21 (2.61-3.94) and 3.12 (2.41-4.04) for NFS. However, we did not observe an independent association of FIB-4 or NFS with overall or cardiovascular mortality in our prospective CAD cohort after full adjustment for all cardiovascular risk factors (all-cause mortality HR 1.13 (0.904-1.41) and 1.17 (0.903-1.52); cardiovascular mortality HR 1.06 (0.8-1.41) and 1.02 (0.738-1.41). Thus, neither FIB-4 nor NFS, as surrogate markers for NAFLD/NASH, were independent risk factors for overall or cardiovascular mortality in patients with CAD.
Conclusion: Our data shows that surrogate risk scores for NAFLD-related fibrosis do not add information in assessing the CVD events in patients with CAD proven by angiography.