Elevated serum ferritin is associated with increased mortality in non-alcoholic fatty liver disease after 16 years of follow-up
Elevated serum ferritin is associated with increased mortality in non-alcoholic fatty liver disease after 16 years of follow-up
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DOI：
10.1111/liv.13144
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发表时间：
2016-11-01
影响因子：
6.7
通讯作者：
Stal, Per
中科院分区：
文献类型：
--
作者：
Hagstrom, Hannes;Nasr, Patrik;Stal, Per
背景与目的非酒精性脂肪性肝病（NAFLD）患者的高水平铁蛋白与显著的纤维化和较高的NAFLD活动评分（NAS）相关。目前尚不清楚这种关联是否对死亡率有影响。我们调查了是否高水平的铁蛋白，有或没有铁超载，与死亡率增加在NAFLD. MethodsWe包括222例1979年和2009年之间的活检证实的NAFLD和可用的血清铁蛋白浓度。将该队列分为高铁蛋白值（n = 89）和正常铁蛋白值（n = 133），使用男性350 g/L和女性150 g/L的临界点，并根据铁过载状态分层。死亡率数据来自全国人口登记册。泊松回归用于估计死亡率的风险比。估计值进行了调整活检，性别，吸烟，BMI，糖尿病，高血压，心血管疾病和纤维化阶段的活检时的年龄。ResultsThe中位数随访时间为15.6年（范围：0.5 - 34.2）。高铁蛋白组纤维化程度和NAS均高于正常组（P <0.05）。诊断后15年，在调整混杂因素后，高铁蛋白组显示出越来越高的死亡率，具有统计学意义（危险比= 1.10/年，95%置信区间1.01 - 1.21，P <0.05）。有不同的铁超载patterns.ConclusionsHigh水平的铁蛋白与长期增加的死亡风险之间的患者的死亡率没有差异。
Background & AimsHigh levels of ferritin in patients with non-alcoholic fatty liver disease (NAFLD) are associated with significant fibrosis and higher NAFLD activity score (NAS). It is unclear if this association has an impact on mortality. We investigated if high levels of ferritin, with or without iron overload, were associated with an increased mortality in NAFLD.MethodsWe included 222 patients between 1979 and 2009 with biopsy-proven NAFLD and available serum ferritin concentrations. The cohort was divided into high' (n = 89) and normal' (n = 133) ferritin values, using a cut-point of 350 g/L in males, and 150 g/L in females, and stratified upon iron overload status. Data on mortality were obtained from a national, population-based register. Poisson regression was used to estimate hazard ratios for mortality. The estimates were adjusted for age at biopsy, sex, smoking, BMI, diabetes, hypertension, cardiovascular disease and fibrosis stage at the time of biopsy.ResultsThe median follow-up time was 15.6 years (range: 0.5-34.2). Patients with high ferritin had more advanced fibrosis and higher NAS than patients with normal ferritin (P < 0.05). Fifteen years after diagnosis, and after adjusting for confounders, the high-ferritin group showed an increasingly higher mortality that was statistically significant (Hazard ratio = 1.10 per year, 95% Confidence interval 1.01-1.21, P < 0.05). There was no difference in mortality between patients with different iron overload patterns.ConclusionsHigh levels of ferritin are associated with a long-term increased risk of death.