Elsaid Mohamed I, Bridges John F P, Li Na, Rustgi Vinod K
Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.
Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio.
Gastro Hep Adv. 2022 Apr 8;1(3):445-456. doi: 10.1016/j.gastha.2022.02.002. eCollection 2022.
Previous studies have examined the effects of metabolic syndrome (MetS) presence rather than the severity on mortality risk in nonalcoholic fatty liver disease (NAFLD). We used the MetS severity score, a validated gender- and race-specific measure, to assess the relationship between MetS severity and mortality risk in NAFLD.
The study included 10,638 adults aged between 20 and 74 years who participated in the Third National Health and Nutrition Examination Survey. NAFLD was defined as mild, moderate, or severe hepatic steatosis on ultrasound without excessive alcohol intake and other liver diseases. Adjusted Cox proportional models were used to test the association between the MetS severity score and mortality risk related to all-cause, heart disease, diabetes, and hypertension.
The median MetS severity score was significantly higher in NAFLD (0.49 [69th] vs -0.23 [41st]). An increase in the MetS severity corresponded to a linear rise in biomarkers for cardiovascular disease, insulin resistance, lipid abnormalities, and liver and kidney problems. The MetS severity score was a significant predictor for all-cause and cause-specific adjusted mortalities. A quartile increase in MetS severity score was associated with higher mortality risks from all-causes adjusted hazard ratio (aHR) 1.36 (95% confidence interval [CI]: 1.17-1.57), heart disease aHR 1.70 (95% CI: 1.17-2.47), diabetes aHR 3.64 (95% CI: 2.27-5.83), and hypertension aHR 1.87 (95% CI: 1.14-3.04). A higher MetS severity score was also associated with nonlinear increased risks of mortality in all adjusted models.
The MetS severity score is a clinically accessible tool that can be used to identify and monitor NAFLD patients at the highest risk of mortality.
既往研究探讨的是非酒精性脂肪性肝病（NAFLD）中代谢综合征（MetS）的存在与否而非其严重程度对死亡风险的影响。我们使用代谢综合征严重程度评分（一种经过验证的、针对性别和种族的测量方法）来评估NAFLD中MetS严重程度与死亡风险之间的关系。
该研究纳入了10638名年龄在20至74岁之间、参与第三次全国健康与营养检查调查的成年人。NAFLD被定义为超声检查显示轻度、中度或重度肝脂肪变性，且无过量饮酒及其他肝脏疾病。采用校正后的Cox比例模型来检验MetS严重程度评分与全因、心脏病、糖尿病和高血压相关死亡风险之间的关联。
NAFLD患者的MetS严重程度评分中位数显著更高（0.49 [第69百分位数] 对比 -0.23 [第41百分位数]）。MetS严重程度的增加与心血管疾病、胰岛素抵抗、脂质异常以及肝脏和肾脏问题的生物标志物呈线性上升相关。MetS严重程度评分是全因和特定病因校正死亡率的显著预测指标。MetS严重程度评分每增加一个四分位数，全因死亡风险升高，校正风险比（aHR）为1.36（95%置信区间[CI]：1.17 - 1.57），心脏病aHR为1.70（95% CI：1.17 - 2.47），糖尿病aHR为3.64（95% CI：2.27 - 5.83），高血压aHR为1.87（95% CI：1.14 - 3.04）。在所有校正模型中，较高的MetS严重程度评分还与死亡率的非线性增加风险相关。
MetS严重程度评分是一种临床可用工具，可用于识别和监测死亡风险最高的NAFLD患者。
