MS10.04 Liver — Pulmonary Disease

Abstract

Evidence of an Association between Pulmonary Dysfunction and Fatty Liver Disease There is an epidemiological association between pulmonary dysfunction and fatty liver disease. Aim: To investigate the association between pulmonary dysfunction and liver steatosis in members of the World Trade Center General Responder Cohort and other populations. FIB-4 scores were calculated from the most recent data in electronic health records; fibrosis was defined as a FIB-4 score ≥2.67, which is associated with a 43-fold increased risk of liver-related mortality. Fatty liver was determined by automated analysis of non-contrast chest CT scans; attenuation <40 Hounsfeld Units (HU) indicated moderate-to-severe steatosis, which means that ≥30% of hepatocytes contain excessive lipid. Primary liver cancer was identified by filtering on international classification of diseases (ICD9/10) codes 155/C22 and verifying the diagnosis by chart review. Multivariable logistic (MVL) regression was used to identify factors independently associated with liver fibrosis and steatosis. All reported findings are significant at p <0.05. Among 18,231 responders, 414 (2.3%) had liver fibrosis, which was associated with lower body mass index (BMI), obstructive pulmonary disease, male sex, smoking history, alcohol history, and less education. Among 7227 responders who denied smoking and/or heavy alcohol consumption, 112 (1.5%) had liver fibrosis, which was again associated with lower BMI, reduced pulmonary function, male sex, and less education. Among 1248 responders with CT scans available for analysis of liver status, 184 (15%) had moderate-to-severe steatosis. Fatty liver was associated with arrival at the WTC site on 9/11 and higher values of ALT, AST, bilirubin, neutrophils, and BMI. Among the responders with fatty liver, 38 (21%) were not obese (BMI <30 kg/m2). The non-obese responders had higher values of ALT, AST, and bilirubin, and lower values of platelets, indicating that they had more advanced liver disease. Thirty-three responders had primary liver cancer. Among WTC responders, liver fibrosis was associated with pulmonary dysfunction and lower BMI; excessive weight and metabolic disease were not the primary drivers. Among responders with liver fat, those with lower BMI had more extensive liver damage, as often occurs in toxicant-associated steatohepatitis (FAMRI, NIOSHU01OH011489).