Peripheral Artery Disease and Risk of Fibrosis Deterioration in Nonalcoholic Fatty Liver Disease:A Prospective Investigation

Objective Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease(NAFLD).Peripheral artery disease(PAD)and liver fibrosis share many common metabolic dysfunctions.We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients.Methods The study recruited 1,610 NAFLD patients aged≥40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015.Fibrosis deterioration was defined as the NAFLD fibrosis score(NFS)status increased to a higher category at the follow-up visit.PAD was defined as an ankle-brachial index of<0.90 or>1.40.Results During an average of 4.3 years’follow-up,618 patients progressed to a higher NFS category.PAD was associated with 92%increased risk of fibrosis deterioration[multivariable-adjusted odds ratio(OR):1.92,95%confidence interval(CI):1.24,2.98].When stratified by baseline NFS status,the OR for progression from low to intermediate or high NFS was 1.74(95%CI:1.02,3.00),and progression from intermediate to high NFS was 2.24(95%CI:1.05,4.80).There was a significant interaction between PAD and insulin resistance(IR)on fibrosis deterioration(P for interaction=0.03).As compared with non-PAD and non-IR,the coexistence of PAD and IR was associated with a 3.85-fold(95%CI:2.06,7.18)increased risk of fibrosis deterioration.Conclusion PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients,especially in those with IR.The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.

Real Time Elastography is an Easy Tool for Diagnosis of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged a major challenge and become the leading indication for liver transplantation. We aimed to assess the applicability and performance of real-time elastography (RTE) in diagnosis of liver fibrosis in patients with NAFLD compared with NAFLD fibrosis score (NFS) and FIB-4 index. Patients and Methods: A prospective case-control study was conducted on 260 subjects attended Hepatology, Gastroenterology and Infectious diseases and Internal Medicine departments in Benha University Hospital from Marsh 20, 2018, to September 1, 2019 and divided into group I included 200 cases with NAFLD and group II included 60 healthy control subjects. Results: There was statistically significant increase in FIB-4 scores between two groups (1.39 ± 1.02 and -0.75 ± 0.32 respectively with p < 0.001), also there was statistically significant increase in NAFLD fibrosis score mean ± SD between two groups (-1.74 ± 1.17 and -2.75 ± 0.91 respectively with p < 0.001). Fibrosis stages in NAFLD patients significantly higher than in control group diagnosed by RTE (P = 0.001). There was an agreement between RTE and FIB-4 index (93%) and NAFLD fibrosis score (86%). Diagnostic performance of RTE in advanced liver fibrosis ≥ F3 was assessed in comparing with FIB-4 index show sensitivity 90%, specificity 93.3%, PPV 60%, NPV 98.8% and accuracy 93% with AUC0.917 (p = 0.001) and in comparing with NAFLD fibrosis score sensitivity 52.6%, specificity 93.8%, PPV 66.7%, NPV 98.4% and accuracy 86% with AUC 0.732 (p = 0.002). Conclusion: Real time elastography could be valuable in diagnosis of fibrosis in NAFLD especially in cases more than F3 score.