Association between liver fibrosis scores and the risk of mortality among patients with coronary artery disease
Association between liver fibrosis scores and the risk of mortality among patients with coronary artery disease
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冠状动脉疾病患者肝纤维化评分与死亡风险之间的关联
DOI：
10.1016/j.atherosclerosis.2020.03.010
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发表时间：
2020-04-01
期刊：
影响因子：
5.3
通讯作者：
Ling, Wenhua
中科院分区：
文献类型：
--
作者：
Chen, Qian;Li, Qing;Ling, Wenhua
背景和目的：脂肪肝在冠心病（CAD）患者中非常普遍，并可能发展为不可逆的肝纤维化。基线肝纤维化（LF）评分是否与CAD患者的长期死亡率相关还需要进一步研究。方法：对中国3263例CAD患者进行前瞻性队列研究。使用Cox模型评估LF评分基线水平（包括非酒精性脂肪性肝病纤维化评分（NFS）、纤维化4评分（FIB-4）、天冬氨酸转氨酶与血小板比率指数（APRI）、γ -谷氨酰转移酶与血小板比率（GPR）和Forns评分）与CAD患者全因和心血管死亡风险的相关性。结果：中位随访时间为7.56年（四分位间距为6.86-8.31年），共发现538例死亡，其中319例死于心血管疾病。与评分最低的患者相比，评分最高的NFS、FIB-4、APRI、GPR和Forns患者全因死亡率的多变量调整hr （95% CI）分别为2.89（2.14-3.91）、2.84（2.14-3.76）、1.77（1.33-2.36）、1.47（1.19-1.83）和3.10(1.88-5.11)，心血管死亡率的多变量调整hr （95% CI）分别为3.02（2.05-4.45）、3.34（2.29-4.86）、1.99（1.40-2.83）、1.80（1.36-2.39）和2.43（1.28-4.61）。当我们排除那些在随访的第一年内死亡的患者或按不同性别、年龄、BMI、糖尿病状况、代谢综合征状况、CAD类型和hsCRP水平分层的患者时，这些关联是一致的。结论：较高的LF评分与CAD患者全因死亡率和心血管死亡率增加相关。LF评分可能在CAD预后预测中发挥潜在作用。
Background and aims: Fatty liver diseases are highly prevalent in patients with coronary artery disease (CAD) and might progress to irreversible liver fibrosis. Whether baseline liver fibrosis (LF) scores are associated with long-term mortality among patients with CAD requires investigation.Methods: The analysis was conducted based on a prospective cohort study among 3263 patients with CAD in China. Cox models were used to assess the association of baseline levels of LF scores, including non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis 4 score (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), gamma-glutamyltransferase to platelet ratio (GPR), and Forns score, with the risk of all-cause and cardiovascular mortality among CAD patients.Results: During a median follow-up period of 7.56 (inter-quartile range: 6.86-8.31) years, 538 deaths were identified, 319 of those were due to cardiovascular diseases. Compared with patients with lowest score levels, multivariable-adjusted HRs (95% CI) for those with highest levels of NFS, FIB-4, APRI, GPR and Forns score were 2.89 (2.14-3.91), 2.84 (2.14-3.76), 1.77 (1.33-2.36), 1.47 (1.19-1.83) and 3.10 (1.88-5.11) for all-cause mortality, 3.02 (2.05-4.45), 3.34 (2.29-4.86), 1.99 (1.40-2.83), 1.80 (1.36-2.39) and 2.43 (1.28-4.61) for cardiovascular mortality, respectively. These associations were consistent when we excluded those who died within the first year of follow-up or stratified patients by different sex, age, BMI, diabetes status, metabolic syndrome status, CAD type and hsCRP level.Conclusions: Higher LF scores are associated with increased risks of all-cause and cardiovascular mortality among CAD patients. LF scores might play a potential role in CAD prognosis prediction.