P0920 - Association of Cardiovascular Disease With Transition From Low to High-Risk for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease (NAFLD)

Myra Quiroga, MD¹, Andrew Schreiner, MD², JingweN Zhang, MS^2
1Medical University of South Carolina, Charleson, SC; ²Medical University of South Carolina, Charleston, SC

Introduction: Advanced fibrosis is the best predictor of future risk for severe liver outcomes in patients with nonalcoholic fatty liver disease (NAFLD). Recently issued NAFLD care guidelines highlight the importance of detecting advanced fibrosis using non-invasive tests, beginning with the Fibrosis-4 Index (FIB-4), and recommend that low-risk patients (FIB-4< 1.3) remain in primary care for ongoing management. Primary care strategies for managing chronic conditions associated with NAFLD, including diabetes and metabolic syndrome, focus on cardiovascular disease (CVD) prevention. How CVD associates with progression from low-risk NAFLD to advanced fibrosis is not fully understood. Our study aims to determine the association between CVD with time to high advanced fibrosis risk in patients with low-risk NAFLD.

Methods: This retrospective cohort study comes from a primary care clinic between 2012 and 2021. Patients with NAFLD were evaluated for laboratory inputs to calculate a FIB-4 score (FIB-4=[Age x AST] / [Platelets x √ALT]). The cohort included patients with NAFLD and a FIB-4 score at low-risk for advanced fibrosis (< 1.3). From the index low-risk FIB-4, patients were followed for the outcome of having a high-risk FIB-4 (>2.67) or until the end of the study period. The primary predictor variable was CVD, a composite of ICD-9/10 codes for coronary artery, cerebrovascular, and peripheral arterial disease. Covariates included demographic and comorbidity variables. Unadjusted and adjusted Cox regression models were developed for the outcome of time to a high-risk FIB-4 score. SAS 9.4 was used for all statistical analyses.

Results: The cohort included 859 patients with a mean age of 50.4 years (± 13.3) and mean body mass index of 33.2 (± 8.1) kg/m². Included patients were 70% female and 40% non-white. Of the cohort, 32%, 36%, and 74% had CVD, diabetes, and hypertension, respectively. During a mean follow-up of 3.8 (± 2.7) years, 9.3% (80) of the sample had a subsequent high-risk FIB-4 score. The multivariable Cox regression model demonstrated a significant association between CVD (HR 2.12; 95%CI 1.32-3.39) and chronic kidney disease (HR 1.92; 95%CI 1.12-3.27) with the time to transition to high advanced fibrosis risk.

Discussion: Our study showed that CVD is associated with an increased risk of progression from low- to high-risk for advanced fibrosis in NAFLD patients. We postulate that control of these comorbidities may prevent fibrosis progression in NAFLD.




Disclosures:


Myra Quiroga, MD¹, Andrew Schreiner, MD², JingweN Zhang, MS². P0920 - Association of Cardiovascular Disease With Transition From Low to High-Risk for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease (NAFLD), ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.