Ali Hasan, Kazmi Maryam, Choi Catherine, Hashemipour Reza, Singh Inderjit, Pyrsopoulos Nikolaos T
Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA.
Cureus. 2021 Aug 20;13(8):e17338. doi: 10.7759/cureus.17338. eCollection 2021 Aug.
Background Non-alcoholic fatty liver disease (NAFLD) is prevalent in almost 25% of the Western population and is predicted to become one of the leading causes of end-stage liver disease. There is increasing evidence that NAFLD is a risk factor for cardiovascular disease, specifically for coronary artery disease, via disruption of the metabolism of glucose and lipids in the body, leading to a state of systemic inflammation that promotes atherosclerosis. This study aims to explore outcomes in patients who underwent percutaneous coronary intervention (PCI) with or without placement of drug-eluting stents (DES) to determine whether the concurrent diagnosis of NAFLD led to worse in-hospital outcomes. Methods We used the National Inpatient Sample, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality 2016 to conduct a cross-sectional study that included all adult patients who underwent PCI with or without placement of DES during hospital admission. Patients with NAFLD were identified and compared to patients without NAFLD. Patients were selected by using ICD-10-CM and ICD-10-PCS codes. Outcomes included mortality, length of stay and total hospital charges, and major adverse cardiac events (MACE). Data on patient demographics, inpatient statistics, and comorbidities were obtained and analyzed using cross-tabulation, Pearson χ test, and independent samples -test. Data were adjusted for confounders using logistic and linear regression. Results Among 429,855 patients who underwent PCI with or without placement of DES, 2,560 patients (0.6%) had a diagnosis of NAFLD. There was no significant difference with regard to mortality and MACE. The NAFLD group had a higher proportion of females, a longer average length of hospital stay, and patients presented at a younger average age. Regarding comorbidities, more patients in the NAFLD group had diabetes mellitus type II, obesity, obstructive sleep apnea (OSA), chronic kidney disease (CKD), and peripheral vascular disease (PVD). Conclusion NAFLD is emerging as a risk factor for cardiovascular disease. Increasing evidence suggests that the disease contributes to systemic atherosclerosis and thus coronary artery disease. We found that among patients who underwent PCI in 2016, those with NAFLD had a longer length of stay, were admitted at a younger age, and had significantly more cardiovascular comorbidities than those without NAFLD. Increasing evidence has shown that advanced liver disease due to NAFLD will continue to place a significant burden on the healthcare system and is, therefore, an area that the medical community should continue to focus on, especially, regarding preventative and therapeutic efforts.
非酒精性脂肪性肝病（NAFLD）在近25%的西方人群中普遍存在，预计将成为终末期肝病的主要原因之一。越来越多的证据表明，NAFLD是心血管疾病，特别是冠状动脉疾病的危险因素，它通过干扰体内葡萄糖和脂质的代谢，导致全身炎症状态，进而促进动脉粥样硬化。本研究旨在探讨接受经皮冠状动脉介入治疗（PCI）并置入或未置入药物洗脱支架（DES）的患者的预后情况，以确定NAFLD的合并诊断是否会导致更差的住院结局。
我们使用了2016年医疗保健研究与质量局（AHRQ）的医疗保健成本和利用项目（HCUP）中的全国住院患者样本进行横断面研究，该研究纳入了所有在住院期间接受PCI并置入或未置入DES的成年患者。识别出患有NAFLD的患者，并与未患NAFLD的患者进行比较。通过使用国际疾病分类第十版临床修正本（ICD-10-CM）和国际疾病分类第十版手术操作编码系统（ICD-10-PCS）编码来选择患者。结局指标包括死亡率、住院时间、总住院费用以及主要不良心脏事件（MACE）。获取患者人口统计学、住院统计数据和合并症数据，并使用交叉表、Pearson χ检验和独立样本t检验进行分析。使用逻辑回归和线性回归对混杂因素进行数据调整。
在429,855例接受PCI并置入或未置入DES的患者中，2560例（0.6%）被诊断为NAFLD。在死亡率和MACE方面没有显著差异。NAFLD组女性比例更高，平均住院时间更长，患者的平均就诊年龄更小。关于合并症，NAFLD组中患有II型糖尿病、肥胖、阻塞性睡眠呼吸暂停（OSA）、慢性肾脏病（CKD）和外周血管疾病（PVD）的患者更多。
NAFLD正逐渐成为心血管疾病的危险因素。越来越多的证据表明，该疾病会导致全身动脉粥样硬化，进而引发冠状动脉疾病。我们发现，在2016年接受PCI的患者中，患有NAFLD的患者住院时间更长，就诊年龄更小，并且心血管合并症明显多于未患NAFLD的患者。越来越多的证据表明，NAFLD所致的晚期肝病将继续给医疗保健系统带来巨大负担，因此，这是医学界应继续关注的领域，尤其是在预防和治疗方面。
