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Colak E, Acar B, Cakir O, Celikyurt U, Baris O, Torun A, Tosun ME, Agir A, Sahin T, Ciftci E. Evaluation of the non-alcoholic fatty liver fibrosis score in predicting short-term outcomes and severe coronary artery disease in patients undergoing coronary computed tomography angiography. Postepy Kardiol Interwencyjnej 2024; 20:45-52. [PMID: 38616939 PMCID: PMC11008510 DOI: 10.5114/aic.2024.136405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/02/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction The correlation between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease is well established. Aim The objective of this study was to assess the short-term associations of the non-alcoholic fatty liver disease fibrosis score (NFS) with various outcomes, including mortality, severe coronary artery disease, myocardial infarction, and the need for coronary angiography, among patients who underwent coronary computed tomographic angiography (CCTA). Material and methods In this study, we assessed 499 patients who underwent 640-slice CCTA and evaluated their liver fibrosis using the NFS. The NFS takes into account factors such as age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase/alanine aminotransferase ratio, platelets, and albumin. Our primary focus was myocardial infarction, the need for coronary angiography, and death. Additionally, we examined the association between NFS and severe coronary artery disease. Results Patients with a higher NFS had a greater number of coronary angiography procedures and higher Agatston score (p < 0.001), with NFS and Agatston score emerging as independent predictors of severe coronary artery disease and the primary endpoint. An NFS value above -0.92 could predict the primary endpoint with 61% sensitivity and 63% specificity, while an NFS value above -0.88 could predict severe coronary artery disease with 62% sensitivity and 65% specificity. To analyze primary endpoints, the Kaplan-Meier method was used for survival analysis, with NFS groups compared using the log-rank test. During the follow-up period, patients with higher NFS were exposed to primary outcomes at an earlier period (p = 0.009). Conclusions NFS is an effective predictor of major cardiovascular events such as death, myocardial infarction, severe coronary artery disease, and the need for coronary angiography. These findings underscore the importance of NFS as a valuable tool for risk assessment and early intervention in patients with suspected or confirmed coronary artery disease.
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Affiliation(s)
- Esra Colak
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Burak Acar
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Umut Celikyurt
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Baris
- Department of Cardiovascular Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Akın Torun
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Eren Tosun
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aysen Agir
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Tayfun Sahin
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ercument Ciftci
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Acar B, Celikyurt U, Agacdiken A, Vural A. Prognostic value of non-alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy. Pacing Clin Electrophysiol 2023; 46:251-257. [PMID: 36593653 DOI: 10.1111/pace.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 12/25/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been shown to predict cardiac events in several patient populations. However, the relationship between NFS and response to CRT has not been investigated. The aim of the study was to investigate the predictive role of NFS in the assessment of response after CRT. METHODS Three hundred thirty-six patients with heart failure undergoing CRT were prospectively studied. Liver fibrosis were assessed according to the non-alcoholic fatty liver disease fibrosis score (NFS), which includes age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase /alanine aminotransferase ratio, platelets, and albumin. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at six months at follow-up. RESULTS Two hundred thirty-eight patients (71%) had CRT response after 6 months of follow-up. Receiver-operator characteristic curve analysis showed NFS cutoff value of < -1.12 for predicting CRT response with a sensitivity of 70.4% and a specificity of 52.9%. The patients were also divided into four groups according to the quartiles of NFS. The proportion of response to CRT was increased with lower level of NFS value. Multivariate logistic regression analysis demonstrated the NFS score < -1.12 and LVIDs were independent predictors of the CRT response. In the second model of analysis which included NFS, quartiles demonstrated that fourth NFS quartile and LVIDs were independent predictors of CRT response. CONCLUSION Liver fibrosis assessed by NFS can provide valuable information to predict reverse remodeling in patients undergoing CRT. The present study supports monitoring of NFS to improve preoperative risk stratification of these patients.
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Affiliation(s)
- Burak Acar
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Umut Celikyurt
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Aysen Agacdiken
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Ahmet Vural
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
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Park H, Yoon EL, Kim M, Lee J, Cho S, Jun DW, Nah EH. Reappraisal of fibrosis-4 index and non-alcoholic fatty liver disease fibrosis score for advanced fibrosis in average-risk population. Front Med (Lausanne) 2022; 9:1024836. [PMID: 36405611 PMCID: PMC9668872 DOI: 10.3389/fmed.2022.1024836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND AND AIM The current cut-offs for fibrosis-4 (FIB-4) and non-alcoholic fatty liver disease fibrosis score (NFS) are suboptimal for screening because of low accuracy and high false-negative rates in average-risk populations. This study aimed to reappraisal the performance of FIB-4 and NFS in such average-risk populations. METHODS This is a cross-sectional study, which retrospectively reviewed the magnetic resonance elastography (MRE) data of 8,522 subjects. Individuals with history of significant alcohol consumption and those with positive viral serologic markers were excluded. Finally, 6,215 average-risk individuals were analyzed. RESULTS The area under the receiver operating characteristic curves (AUROCs) of FIB-4 for the diagnosis of advanced hepatic fibrosis was higher than that in the NFS especially in the metabolically healthy. The AUROCs of FIB-4 for in the average-risk population was also higher than that in the NFS (0.840 in FIB-4 vs. 0.798, P = 0.036). However, the sensitivity of FIB-4 and NFS was low (69.6 and 61.4%, respectively) in applying the current cut-off of FIB-4 [1.3 (2.0)] and NFS [-1.455 (0.12)]. At cut-off of FIB-4 at 1.0, sensitivity (90.2%), and negative predictive value (99.7%) were improved. CONCLUSION The diagnostic performance of FIB-4 was better than that of NFS for screening hepatic fibrosis in average-risk populations. It is recommended to use FIB-4 rather than NFS, when screening for hepatic fibrosis in general population.
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Affiliation(s)
- Huiyul Park
- Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Eileen L. Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, South Korea
| | - Mimi Kim
- Department of Radiology, Hanyang University College of Medicine, Seoul, South Korea
| | - Jonghyun Lee
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, South Korea
| | - Seon Cho
- Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, South Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, South Korea
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, South Korea
| | - Eun-Hee Nah
- Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, South Korea
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Park H, Yoon EL, Kim M, Lee J, Kim JH, Cho S, Jun DW, Nah EH. Comparison of diagnostic performance between FIB-4 and NFS in metabolic-associated fatty liver disease era. Hepatol Res 2022; 52:247-254. [PMID: 34841632 DOI: 10.1111/hepr.13737] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
AIMS Fibrosis-4 index (FIB-4) and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) are the two most widely used non-invasive tools for screening of advanced fibrosis in subjects with NAFLD. Since metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new category of fatty liver disease, we aimed to compare the diagnostic performance of FIB-4 and NFS in subjects with MAFLD and in various subgroups. METHODS This study was designed as cross-sectional study. Data from 6775 subjects who underwent magnetic resonance elastography (MRE) and abdominal ultrasonography at the same time during a health check-up at 13 various health check-up centers were retrospectively reviewed. Advanced fibrosis was defined as an MRE value of ≥3.6 kPa. RESULTS The area under the receiver operating characteristic curves (AUROCs) of FIB-4 and NFS for diagnosing advanced fibrosis were similar in subjects with MAFLD. However, the AUROC of NFS was lower than that of FIB-4 in the diabetic subgroup of MAFLD (0.809 in FIB-4 vs. 0.717 in NFS, p = 0.002). The performances of both FIB-4 and NFS were poor in the subgroup of MAFLD with significant alcohol intake. CONCLUSIONS The overall diagnostic performance of FIB-4 and NFS for diagnosing advanced fibrosis did not differ among subjects with MAFLD. However, the performance of NFS was lower in the diabetes subgroup of MAFLD. The diagnostic performance of FIB-4 was better for fibrosis in various subgroups of MAFLD.
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Affiliation(s)
- Huiyul Park
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Gyeonggi-do, Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mimi Kim
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Jonghyun Lee
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Korea
| | - Jung-Hwan Kim
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Gyeonggi-do, Korea
| | - Seon Cho
- Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.,Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Korea
| | - Eun-Hee Nah
- Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, Korea
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Lv Y, Zhang HJ. Effect of Non-alcoholic Fatty Liver Disease on the Risk of Synchronous Liver Metastasis: Analysis of 451 Consecutive Patients of Newly Diagnosed Colorectal Cancer. Front Oncol 2020; 10:251. [PMID: 32181157 PMCID: PMC7059642 DOI: 10.3389/fonc.2020.00251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/13/2020] [Indexed: 12/24/2022] Open
Abstract
Background: The purpose of this study was to investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the risk of synchronous colorectal liver metastasis (synCRLM). Methods: A retrospective analysis was performed on 451 consecutive patients with newly diagnosed colorectal cancer (CRC) from January 2014 to January 2019. According to the presence of NAFLD, the CRC patients were divided into two groups, NAFLD group (60 cases) and the control group (391 cases). The clinicopathological features and the prevalence of synCRLM between the two groups were compared. Logistic regression analysis was used to analyze the risk factors of synCRLM. Different non-invasive liver fibrosis scoring models were used to evaluate the effect of advanced fibrosis and cirrhosis stage in NAFLD on the prevalence of synCRLM. Results: The prevalence of synCRLM was significantly higher in patients with NAFLD than that in patients without NAFLD (18.33 vs. 7.42%; χ2 = 7.669, P = 0.006). A logistic regression analysis indicated that NAFLD, CEA, CA19-9, and lymph node status were risk factors for synCRLM, and NAFLD showed the highest hazard ratio (3.930 [95% confidence interval: 1.616 ~ 9.560]). In NAFLD patients, both fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) were significantly lower in those with synCRLM compared to those without synCRLM [FIB-4: 1.246 (0.833 ~ 1.276) vs. 1.436 (1.016 ~ 2.699), Z = −2.130, P = 0.033; NFS: −1.282 (−2.407 ~ −0.262) vs. −0.255 (−1.582 ~ 0.755), Z = −2.302, P = 0.021; Mann-Whitney test]. Conclusion: NAFLD may be associated with increased liver metastasis, and for NAFLD-related advanced liver fibrosis and cirrhosis may be associated with reduced synchronous liver metastasis in CRC patients. However, the correlation between simple steatosis and steatohepatitis remains to be further determined. Certain factors such as NAFLD, lymph node metastasis, elevated levels of preoperative CEA and CA19-9 are suggesting a high risk of synCRLM.
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Affiliation(s)
- Yan Lv
- Department of Oncology, The Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Hai-Jun Zhang
- Department of Oncology, The Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
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Yahagi M, Tsuruta M, Hasegawa H, Okabayashi K, Kitagawa Y. Non-alcoholic fatty liver disease fibrosis score predicts hematological toxicity of chemotherapy including irinotecan for colorectal cancer. Mol Clin Oncol 2017; 6:529-533. [PMID: 28413661 DOI: 10.3892/mco.2017.1177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/13/2017] [Indexed: 01/06/2023] Open
Abstract
Liver dysfunction that may affect drug metabolism is a major concern in patients treated with chemotherapy. Thus, assessment of the degree of liver dysfunction is crucial for predicting the adverse events of chemotherapy. The non-alcoholic fatty liver disease fibrosis score (NFS) is a non-invasive clinical scoring system constructed from routine clinical and laboratory variables. The aim of this study was to evaluate whether NFS was useful for predicting the adverse events of chemotherapy including irinotecan (CPT-11) for colorectal cancer. Between January, 2007 and May, 2013, a total of 87 patients with unresectable/recurrent colorectal cancer who received first-line chemotherapy including CPT-11 were reviewed. Demographic variables, including pretreatment NFS, were retrospectively collected from medical records. The primary outcome was the association between pretreatment NFS and adverse events, such as hematological and non-hematological toxicity, of chemotherapy including CPT-11. The median pretreatment NFS was 1.302 (range, 5.158-2.620). Pretreatment NFS was an independent risk factor for hematological toxicity in a multivariate analysis (coefficient=0.932, 95% CI: 0.083-1.781; P=0.031). Receiver operating characteristic curve analysis identified 0.347 as the optimal cut-off value associated with hematological toxicity. Using this cut-off, high NFS was found to be a significant risk factor for hematological toxicity (coefficient=2.019, 95% CI: 0.239-3.798, P=0.026), but not for non-hematological toxicity (P=0.546). Therefore, based on these results, NFS appears to be a significant predictor of hematological adverse events in chemotherapy including CPT-11 for colorectal cancer and it is a non-invasive, useful tool that may be used for determining regimens or doses of chemotherapy including CPT-11.
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Affiliation(s)
- Masashi Yahagi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Xun YH, Guo JC, Lou GQ, Jiang YM, Zhuang ZJ, Zhu MF, Luo Y, Ma XJ, Liu J, Bian DX, Shi JP. Non-alcoholic fatty liver disease (NAFLD) fibrosis score predicts 6.6-year overall mortality of Chinese patients with NAFLD. Clin Exp Pharmacol Physiol 2015; 41:643-9. [PMID: 24837195 DOI: 10.1111/1440-1681.12260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 11/27/2022]
Abstract
The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has emerged as a useful predictor of long-term outcome in NAFLD patients. We evaluated the predictive performance of the NFS for overall mortality in a Chinese population with NAFLD. All NAFLD patients diagnosed ultrasonographically at Xixi Hospital of Hangzhou between 1996 and 2011 were retrospectively recruited to the study. Outcome was determined by interview and causes of death were confirmed by medical records. The area under the receiver operating characteristic curve (AUCROC ) was used to determine the predictive accuracy of the NFS, BARD (body mass index, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, diabetes) score, FIB-4 index and the AST/platelet ratio index (APRI) for mortality. Data from a total of 180 eligible patients (median age 39 years; 96 men) were analysed, with 12 deaths over a median follow-up period of 6.6 years (range 0.5-14.8 years). Using Cox model analysis, the NFS as a continuous variable was identified as the only predictor for all-cause mortality (hazard ratio 2.743, 95% confidence interval (CI) 1.670-4.504). The NFS yielded the highest AUCROC of 0.828 (95% CI 0.728-0.928, P < 0.05), followed by the FIB-4 index, APRI and BARD score (AUCROC 0.806 (P < 0.05), 0.732 (P < 0.05) and 0.632, respectively). The data indicated that the NFS is a useful predictor of 6.6-year all-cause mortality for Chinese patients with NAFLD.
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Affiliation(s)
- Yun-Hao Xun
- Department of Liver Diseases, Xixi Hospital of Hangzhou, Hangzhou, Zhejiang, China
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Takahashi Y, Kurosaki M, Tamaki N, Yasui Y, Hosokawa T, Tsuchiya K, Nakanishi H, Itakura J, Izumi N. Non-alcoholic fatty liver disease fibrosis score and FIB-4 scoring system could identify patients at risk of systemic complications. Hepatol Res 2015; 45:667-75. [PMID: 25145976 DOI: 10.1111/hepr.12405] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 08/06/2014] [Accepted: 08/18/2014] [Indexed: 12/22/2022]
Abstract
AIM To investigate the relation between systemic complications of non-alcoholic fatty liver disease (NAFLD) and non-invasive fibrosis scores. METHODS The NAFLD fibrosis score (NFS) and FIB-4 were measured in 1559 people who underwent a complete medical checkup at our hospital and were followed for more than 3 years. Correlation between these scores and prevalence and new incidence rates of diabetes or cerebral-cardiovascular diseases were analyzed. RESULTS The 1559 cases were classified into two groups using the low cut-off values of NFS and FIB-4: group 1 (≥low cut-off score with fatty liver) and group 2 (the others). In group 1, the prevalence of diabetes and cerebral-cardiovascular diseases at baseline and additional incidences during the observation period was higher compared with group 2. Diabetes at baseline in group 1 versus group 2 were 31.5% versus 3.1% (NFS, P < 0.0001), 17.0% versus 4.7% (FIB-4, P < 0.0001), and cerebral-cardiovascular diseases at baseline were 7.7% versus 2.3% (NFS, P = 0.002) and 9.0% versus 2.3% (FIB-4, P = 0.0012). New incidences of diabetes were 4.5% versus 1.2% (NFS, P = 0.034) and 3.6% versus 1.2% (FIB-4, P = 0.11), and of cerebral-cardiovascular diseases were 5.0% versus 0.9% (NFS, P = 0.0019) and 5.4% versus 0.9% (FIB-4, P = 0.0034). CONCLUSION NFS and FIB-4 are useful to extract cases with high risk of systemic complications of NAFLD in the public.
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Affiliation(s)
- Yuka Takahashi
- Department of Medical Health Checkup Center, Musashino Red Cross Hospital, Tokyo, Japan.,Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yutaka Yasui
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Takanori Hosokawa
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hiroyuki Nakanishi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Jun Itakura
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Medical Health Checkup Center, Musashino Red Cross Hospital, Tokyo, Japan.,Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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