van Kleef Laurens A, Sonneveld Milan J, Zhu Fang, Ikram M Arfan, Kavousi Maryam, de Knegt Robert J
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Liver Int. 2023 May;43(5):1000-1007. doi: 10.1111/liv.15538. Epub 2023 Mar 8.
Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD).
We analysed individuals enrolled in the ongoing prospective population-based Rotterdam Study who attended a visit between 2009-2014 that included liver stiffness measurement. Exclusion criteria for the primary analysis were incomplete data on heart failure, unreliable liver stiffness, alcohol abuse and viral hepatitis, leaving 4.153 participants (aged 67.5 ± 8.4 years, 44.2% male) for analysis with a median follow-up of 6.0 (interquartile range: 5.1-7.0) years. Secondary analysis included participants with viral hepatitis, alcohol abuse and/or unreliable measurement. The association between liver stiffness and mortality was assessed using Cox regression. Associations between heart failure, CHD, and echocardiographic characteristics and liver stiffness were quantified with linear regression.
Liver stiffness ≥8.0 kPa was associated with mortality (aHR: 1.37, 95%CI: 1.00-1.89). However, this was driven by participants with heart failure (aHR: 2.48, 95%CI: 1.15-5.35), since high liver stiffness was not associated with mortality in participants without heart failure and/or CHD (aHR: 1.07, 95%CI: 0.70-1.64). Results were consistent when individuals with viral hepatitis, alcohol abuse or unreliable liver stiffness measurement were not excluded. Several cardiovascular characteristics were significantly associated with higher liver stiffness, e.g. heart failure, moderate/poor diastolic dysfunction, and right atrium diameter > 4.5 cm.
In our cohort of community-dwelling elderly, high liver stiffness was associated with excess mortality, primarily explained by participants with heart failure. Moreover, heart failure and its indicators were associated with increased liver stiffness.
肝脏硬度升高反映肝纤维化，但也可能继发于静脉淤血。我们旨在研究普通人群中肝脏硬度与死亡率之间的关联，并根据心力衰竭和/或冠心病（CHD）进行分层。
我们分析了正在进行的基于鹿特丹前瞻性人群研究中2009年至2014年间参加过包含肝脏硬度测量的访视的个体。主要分析的排除标准为心力衰竭数据不完整、肝脏硬度不可靠、酗酒和病毒性肝炎，剩余4153名参与者（年龄67.5±8.4岁，44.2%为男性）进行分析，中位随访时间为6.0年（四分位间距：5.1 - 7.0年）。二次分析纳入了患有病毒性肝炎、酗酒和/或测量不可靠的参与者。使用Cox回归评估肝脏硬度与死亡率之间的关联。通过线性回归量化心力衰竭、冠心病以及超声心动图特征与肝脏硬度之间的关联。
肝脏硬度≥8.0 kPa与死亡率相关（调整后风险比：1.37，95%置信区间：1.00 - 1.89）。然而，这是由心力衰竭患者驱动的（调整后风险比：2.48，95%置信区间：1.15 - 5.35），因为在没有心力衰竭和/或冠心病的参与者中，高肝脏硬度与死亡率无关（调整后风险比：1.07，95%置信区间：0.70 - 1.64）。当不排除患有病毒性肝炎、酗酒或肝脏硬度测量不可靠的个体时，结果一致。几个心血管特征与较高的肝脏硬度显著相关，例如心力衰竭、中度/重度舒张功能障碍以及右心房直径>4.5 cm。
在我们的社区居住老年人队列中，高肝脏硬度与额外死亡率相关，主要由心力衰竭患者解释。此外，心力衰竭及其指标与肝脏硬度增加相关。
