Objective Measures of Cardiometabolic Risk and Advanced Fibrosis Risk Progression in Primary Care Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease.

Autor:	Schreiner AD; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: schrein@musc.edu., Zhang J; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Moran WP; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Koch DG; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Marsden J; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Bays C; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Mauldin PD; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina., Gebregziabher M; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Jazyk:	angličtina
Zdroj:	Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists [Endocr Pract] 2024 Nov; Vol. 30 (11), pp. 1015-1022. Date of Electronic Publication: 2024 Aug 08.
DOI:	10.1016/j.eprac.2024.08.002
Abstrakt:	Background: We examined the association of objective measures of cardiometabolic risk with progression to a high-risk for advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) at initially low- and indeterminate-risk for advanced fibrosis. Methods: We performed a retrospective cohort study of primary care patients with MASLD between 2012 and 2021. We evaluated patients with MASLD and low- or indeterminate-risk Fibrosis-4 Index (FIB-4) scores and followed them until the outcome of a high-risk FIB-4 (≥2.67), or the end of the study period. Exposures of interest were body mass index, systolic blood pressure, hemoglobin A1c, cholesterol, estimated glomerular filtration rate, and smoking status. Variables were categorized by the threshold for primary care therapy intensification. Unadjusted and adjusted Cox regression models were developed for the outcome of time to a high-risk FIB-4 value. Results: The cohort included 1347 patients with a mean follow-up of 3.6 years (SD 2.7). Of the cohort, 258 (19%) had a subsequent FIB-4 > 2.67. In the fully adjusted Cox regression models, mean systolic blood pressure ≥ 150 mm Hg (1.57; 95% confidence interval (CI) 1.02-2.41) and glomerular filtration rate ≤ 59 ml/min (hazard ratio 2.78; 95%CI 2.17-3.58) were associated with an increased hazard of a high-risk FIB-4, while receiving a statin prescription (hazard ratio 0.51; 95%CI 0.39-0.66) was associated with a lower risk. Conclusions: Nearly 1 in 5 primary care patients with MASLD transitioned to a high-risk FIB-4 score during 3.6 years of follow-up, and uncontrolled blood pressure and reduced kidney function were associated with an increased hazard of a FIB-4 at high-risk for advanced fibrosis. Competing Interests: Disclosure The authors have no conflicts of interest to disclose. (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu