Liver Unit/ Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, St Mary's Hospital Campus, Imperial College London, London, UK.
Department of Surgery and Cancer, Centre for Computational and System Medicine, Imperial College London, London, UK.
Aliment Pharmacol Ther. 2019 Apr;49(8):1077-1085. doi: 10.1111/apt.15192. Epub 2019 Mar 5.
Atherosclerotic cardiovascular disease is a key cause of morbidity in non-alcoholic fatty liver disease (NAFLD) but appropriate means to predict major acute cardiovascular events (MACE) are lacking.
To design a bespoke cardiovascular risk score in NAFLD.
A retrospective derivation (2008-2016, 356 patients) and a prospective validation (2016- 2017, 111 patients) NAFLD cohort study was performed. Clinical and biochemical data were recorded at enrolment and mean platelet volume (MPV), Qrisk2 and Framingham scores were recorded one year prior to MACE (Cardiovascular death, acute coronary syndrome, stroke and transient ischaemic attack).
The derivation and validation cohorts were well-matched, with MACE prevalence 12.6% and 12%, respectively. On univariate analysis, age, diabetes, advanced fibrosis, collagen proportionate area >5%, MPV and liver stiffness were associated with MACE. After multivariate analysis, age, diabetes and MPV remained independently predictive of MACE. The "NAFLD CV-risk score" was generated using binary logistic regression: 0.06*(Age) + 0.963*(MPV) + 0.26*(DM ) - 16.44; Diabetes mellitus: 1: present; 2: absent. (AUROC 0.84). A cut-off of -3.98 gave a sensitivity 97%, specificity 27%, PPV 16%, and NPV 99%. An MPV alone of >10.05 gave a sensitivity 97%, specificity 59%, PPV 24% and NPV 97% (AUROC 0.83). Validation cohort AUROCs were comparable at 0.77 (NAFLD CV-risk) and 0.72 (MPV). In the full cohort, the NAFLD CV-risk score and MPV outperformed both Qrisk2 and Framingham scores.
The NAFLD CV risk score and MPV accurately predict 1-year risk of MACE, thereby allowing better identification of patients that require optimisation of their cardiovascular risk profile.
动脉粥样硬化性心血管疾病是非酒精性脂肪性肝病（NAFLD）患者发病和致残的主要原因，但目前尚缺乏准确预测主要不良心血管事件（MACE）的方法。
设计一种用于预测非酒精性脂肪性肝病患者发生心血管事件风险的评分系统。
采用回顾性队列研究（2008-2016 年，356 例患者）和前瞻性队列研究（2016-2017 年，111 例患者），记录患者入组时的临床和生化数据，以及 MACE 发生前 1 年的平均血小板体积（MPV）、Qrisk2 评分和Framingham 评分。MACE 定义为心血管死亡、急性冠状动脉综合征、卒中和短暂性脑缺血发作。
回顾性队列和前瞻性队列的患者基线特征匹配，MACE 发生率分别为 12.6%和 12%。单因素分析显示，年龄、糖尿病、晚期纤维化、胶原面积比>5%、MPV 和肝硬度与 MACE 相关。多因素分析显示，年龄、糖尿病和 MPV 是 MACE 的独立预测因素。采用二项逻辑回归生成“NAFLD CV 风险评分”：0.06×（年龄）+0.963×（MPV）+0.26×（糖尿病）-16.44；糖尿病：1=存在；2=不存在。（AUROC 为 0.84）。截断值为-3.98 时，该评分的灵敏度为 97%，特异度为 27%，阳性预测值为 16%，阴性预测值为 99%。MPV 单独升高（>10.05）的灵敏度为 97%，特异度为 59%，阳性预测值为 24%，阴性预测值为 97%（AUROC 为 0.83）。验证队列的 AUROC 分别为 0.77（NAFLD CV 风险评分）和 0.72（MPV）。在全队列中，NAFLD CV 风险评分和 MPV 优于 Qrisk2 评分和Framingham 评分。
NAFLD CV 风险评分和 MPV 可准确预测 1 年 MACE 风险，有助于更好地识别需要优化心血管风险状况的患者。
