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Liver fibrosis, NT-ProBNP and mortality in patients with MASLD: A population-based cohort study

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Ciardullo, Stefano, Cannistraci, Rosa, Muraca, Emanuele, Zerbini, Francesca, Perseghin, Gianluca·2024·Nutrition, Metabolism and Cardiovascular Diseases
DOI 10.1016/j.numecd.2023.11.011
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Abstract

Background & aim Liver fibrosis is the strongest predictor of liver-related mortality in many chronic liver diseases. NT-ProBNP is independently associated with cardiovascular mortality in general population settings. Here, we evaluate the relative contribution of non-invasively identified liver fibrosis and NT-ProBNP on all-cause and cardiovascular mortality in patients with metabolic (dysfunction)-associated steatotic liver disease (MASLD). Methods and results Serum NT-ProBNP levels were measured in 4229 patients with MASLD from the general population without a known history of heart failure that participated in the 1999-2004 cycles of the National Health and Nutrition Examination Survey. Presence of liver fibrosis was estimated using the Fibrosis-4 index (FIB-4). We applied Cox proportional hazard models adjusted for cardiovascular risk factors to evaluate the association between NT-ProBNP and FIB-4 levels and all-cause and cardiovascular mortality through December 2019. Mortality was lower for participants with normal levels of both biomarkers, intermediate if a single biomarker was elevated and highest when both were above the chosen threshold. In the multivariable-adjusted models, both elevated FIB-4 (≥2.67) and elevated NT-ProBNP levels (≥125 pg/ml) were independently associated with higher risks of all-cause mortality (HR 2.2, 95 % CI 1.5-3.2 and HR 1.6, 95 % CI 1.4-2.0, respectively) and cardiovascular mortality (HR 2.1, 95 % CI 1.2-3.7 and HR 2.1, 95 % CI 1.5-2.9, respectively). The associations remained consistent in subgroup analyses based on sex, obesity and age. Conclusions Both FIB-4 and NT-ProBNP are independently associated with higher mortality in patients with MASLD. Their combined use might prove useful to risk-stratify patients in clinical practice.

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Metadata

Authors
Ciardullo, S., Cannistraci, R., Muraca, E., Zerbini, F., & Perseghin, G.
Affiliations
University of Milano-Bicocca (IT)
Corresponding author
  • Ciardullo, Stefano
  • Cannistraci, Rosa
  • Muraca, Emanuele
  • Zerbini, Francesca
  • Perseghin, Gianluca
ORCID
Venue
Nutrition, Metabolism and Cardiovascular Diseases
Publisher
Elsevier BV
Published
2024-04
Volume
34
Issue
4
Pages
963-971
ISSN
0939-4753 (ISSN-L)
DOI
10.1016/j.numecd.2023.11.011
OpenAlex
W4388871659
Cited by
20
References
4
Citations by year
2026: 6 · 2025: 7 · 2024: 7
FWCI
3.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrition Metabolism and Cardiovascular Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • BOA (University of Milano-Bicocca) (submittedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
non-alcoholic fatty liver disease, liver fibrosis, NT-proBNP, FIB-4, all-cause mortality, cardiovascular mortality, noninvasive fibrosis assessment, risk stratification, obesity
MeSH terms
Heart Failure, Humans, Liver Cirrhosis, Nutrition Surveys, Peptide Fragments, Prognosis, Cohort Studies, Biomarkers, Natriuretic Peptide, Brain

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