1103 Can Non-invasive Markers of Liver Histology for Non-Alcoholic Fatty Liver Disease (NAFLD) Help Predict Cardiovascular Risk by Application of the Framingham Scoring System?

Abstract

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developed countries with a prevalence of 25%-30%. Independent of cardiovascular and metabolic risk factors, NAFLD is associated with the progression of coronary atherosclerosis. The Framingham risk score (FRS) is useful in identifying patients at higher 10-year coronary heart disease risk. We aim to creative a simple, safe, cost-effective and non-invasive method for diagnosing NAFLD and assigning a cardiovascular risk. METHODS: In this retrospective analysis, 1038 adult patients who underwent a liver biopsy between the years of 2009 – 2016 were examined. NAFLD was diagnosed on the basis of histology after the exclusion of alcohol, viral, metabolic and autoimmune liver disease by chart review. Clinical and laboratory data was collected from the time of the liver biopsy. The NAFLD Activity Score was used to histologically classify our patients into different degrees of steatohepatitis. From the initial 1038 patients, 276 patients were identified to have steatosis on histology (< 5% steatosis excluded). We calculated the FRS score based on a standard score sheet that is gender specific and includes the following variables: age, blood pressure, total cholesterol, HDL-cholesterol, smoking history and history of diabetes. To conform to the FRS, we included only patients between 30-74 years old. Non-invasive scores for liver fibrosis such as AST platelet ratio index, BARD, Fibrosis-4 index, and NAFLD fibrosis score were calculated for the remaining 50 patients and compared to the liver histology graded by the NAFLD Activity Score and to the FRS. RESULTS: Regression of our variables showed a positive association between AST platelet ratio index with the FRS, 2.71 (P = 0.0162), and a negative association between the BARD score and FRS 1.38 (P = 0.0189). The remaining non-invasive scores (FIB-4, NFS) did not show a statistically significant association with the FRS. Finally, the NAS score did not show a statistically significant association with the FRS score. CONCLUSION: The APRI score can accurately predict the degree of liver fibrosis in a patient with NAFLD and the FRS can readily be calculated in NAFLD patients that may be at highest risk of CHD outcomes and could benefit from an intervention. Our study was limited due to a small sample size, which may attribute to the lack of statistical significant association between FIB4, NFS, and the NAS to the FRS and the 10 year risk of coronary heart disease.