New Marker for Risk in Fatty Liver Disease

Patients with fatty liver disease are at higher risk of dying if they have a high aspartate aminotransferase to platelet ratio index (APRI), federal researchers in the US report.

In an abstract to be presented at the International Liver Congress in Barcelona, Anbur Unalp Arida and Constance Ruhl of the National Institutes of Health, Bethesda, MD looked at whether the APRI inidex, a non-invasive marker of liver fibrosis was associated with increased overall and cause-specific mortality.

In their study they looked at 23 years of linked-mortality data.

Fatty liver disease is a growing problem both in the US and globally, due to changing lifestyles, they noted.

Data were analyzed from 14,267 adult participants in the third U.S. National Health and Nutrition Examination Survey (NHANES), 1988-1994, who were negative for viral hepatitis B or C or iron overload.

An intermediate to high probability of liver fibrosis was defined as APRI >0.5. Participants were passively followed for mortality, as identified by death certificate underlying or contributing cause diagnoses, by linkage to National Death Index records through 2011. Hazard rate ratios (HR) for mortality were calculated using Cox proportional hazards regression to adjust for common mortality risk factors.

Their results showed that the prevalence of intermediate to high liver fibrosis probability using APRI >0.5 as a marker was 3.4%. During follow-up, there were 4,554 deaths from all causes, including 1,890 with cardiovascular disease, 1,141 with cancer, 562 with diabetes, and 130 with liver disease including primary liver cancer. A higher APRI was associated with increased liver disease mortality in age-adjusted analysis (HR, 13.6; 95% CI, 7.6-24.5) and the risk remained almost 9 times higher with multi variate adjustment (Figure). Mortality was also increased from all-causes in both age-adjusted (HR, 1.4; 95% CI, 1.2-1.8) and multivariate-adjusted (Figure) analyses, and with cancer. In contrast, there was no association of a higher APRI with cardiovascular disease mortality in age-adjusted (HR, 1.1; 95% CI, 0.8-1.6) or multivariate-adjusted (Figure) analyses, or with diabetes mortality after controlling for other risk factors. When participants with hepatitis C virus were included in the analysis, results were similar to the main analysis for liver disease (adjusted HR, 11.6; 95% CI, 6.9-19.5) and other mortality outcomes.

They concluded that APRI was a valid and non-invasive marker for higher risk of mortality.

“In the U.S. population, intermediate to high liver fibrosis probability using APRI was associated with increased mortality from liver disease, cancer, and all-causes, but was not associated with cardiovascular disease or diabetes mortality,” they wrote.