Metabolic Syndrome and Male Gender are the Important Predictors of Significant Liver Fibrosis in Patients with Moderate to Severe Psoriasis as Detected by Transient Elastography

Abstract

Background: Many international guidelines on psoriasis management have emphasized upon need to identify risk factors for liver fibrosis and the risk may be increased after a certain total cumulative dose of methotrexate. Materials and Methods: Consecutive patients with moderate to severe psoriasis were assessed for liver fibrosis using transient elastography and non-invasive scores. Based on the presence of significant liver fibrosis, Odd's ratio associated with various factors was calculated using logistic regression analysis. Receiver Operating Characteristic (ROC) curves to be calculated to find maximal cut-off values of non-invasive tests to detect fibrosis. Results: Of 159 patients, 134 patients completed the study. Significant fibrosis (LSM ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Male sex (p=0.024) and presence of MS (p=0.034) were the only variables associated with significant liver fibrosis. On logistic regression analysis, O.R. for male gender and metabolic syndrome was estimated to be 2.51 (95% CI - 1.09-5.81) and 2.33 (95% CI - 1.03-5.27) respectively. APRI, NAFLD score and Fib-4 index had low accuracy in comparison to transient elastography. Conclusion: MS and male sex are the most important risk factors for development of significant liver fibrosis in psoriasis patients. Methotrexate exposure does not seem to predict presence of liver fibrosis. Funding Statement: The authors declare: None. Declaration of Interests: The authors declare: None. Ethics Approval Statement: The study was initiated after taking approval from the Institute’s ethics committee (NK/978/Res/351). In addition, a STROBE checklist is included.