Hyperuricemia Is Associated with Significant Liver Fibrosis in Subjects with Nonalcoholic Fatty Liver Disease, but Not in Subjects without It.

Pei-Chia Yen,Chih-Hsing Wu,Zih-Jie Sun,Chung-Hao Li,Yu-Tsung Chou,Chih-Jen Chang,Jin-Shang Wu,Feng-Hwa Lu,Yin-Fan Chang,Yi-Ching Yang

doi:10.3390/jcm11051445

Abstract

Liver fibrosis is associated with liver-related outcomes, yet often remains underdiagnosed in primary care settings. Hyperuricemia is associated with non-alcoholic fatty liver disease (NAFLD), but the relationship between hyperuricemia and liver fibrosis remains unclear. Data on individuals without NAFLD is also limited. We investigated the association between hyperuricemia and liver fibrosis in subjects with and without NAFLD. This study recruited 11,690 relevant participants from a health-checkup center. NAFLD was based on ultrasonography. Hyperuricemia was defined as serum uric acid > 6.0 mg/dL in women and >7.0 mg/dL in men. Significant liver fibrosis was diagnosed with the aspartate aminotransferase to platelet ratio index ≥0.5. The following were positively associated with significant liver fibrosis: hyperuricemia (p = 0.001), age ≥ 65 years (p < 0.001), male gender (p < 0.001), obesity (p = 0.009), hypertension (p = 0.002), diabetes (p < 0.001), and NAFLD (p < 0.001) in the logistic regression. The positive association of hyperuricemia with significant liver fibrosis remained in subjects with NAFLD (p = 0.001), but not in subjects without NAFLD. In conclusion, hyperuricemia increased the associated risk of significant liver fibrosis. The positively associated risk existed in subjects with NAFLD, but not in those without it.

Highlights

Non-alcoholic fatty liver disease (NAFLD) affects more than 25% of the global population, being the most common cause of chronic liver disease both in Western countries and inAsia [1,2]
Subjects with significant liver fibrosis had a higher prevalence of obesity, hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus, hyperuricemia, and NAFLD, but a lower platelet counts and HDL-C than those without it
The following variables were positively associated with significant liver fibrosis: hyperuricemia (OR = 1.39, 95% CI: 1.15–1.69, p = 0.001), age ≥ 65 years, male gender, obesity, hypertension, diabetes, and NAFLD

Summary

Introduction

It has become a rising culprit leading to cirrhosis and even hepatocellular carcinoma [2]. Fibrosis stages are associated with liver-related outcomes and all-cause mortality in a dose-dependent manner [3]. Noninvasive assessments for liver fibrosis have been developed, including biochemical serum markers, such as the aspartate aminotransferase (AST) to platelet ratio index (APRI), NAFLD fibrosis score (NFS), the Fibrosis-4 (FIB-4) Index, and the BARD score (body mass index (BMI), the AST/alanine aminotransferase (ALT) ratio, and diabetes mellitus), as well as image tests using transient elastography (FibroScan) or magnetic resonance elastography (MRE) [5]. The APRI has the advantage of using only two readily accessible primary care parameters while maintaining good ability to differentiate subjects with significant fibrosis from those without it [6–10]

Methods

Results

Discussion

Conclusion