Liver disease prevalence and severity in people with serious mental illness: a cross-sectional analysis using non-invasive diagnostic tools,Hepatology International

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Liver disease prevalence and severity in people with serious mental illness: a cross-sectional analysis using non-invasive diagnostic tools
Hepatology International ( IF 5.9 ) Pub Date : 2021-06-03 , DOI: 10.1007/s12072-021-10195-6
Michael Rudi Braude ₁ , Danny Con ₂ , John Lubel _{3,

4} , Abhijit Bidwai , Hoang-Thy Nguyen ₅ , Shipra Sharmamiglani ₅ , David Clarke _{5,

6} , Anouk Dev _{1,

4} , William Sievert _{1,

4}

Affiliation

Background/purpose of the study

Little is known about all-cause liver disease in people with serious mental illness (SMI), despite heightened risk factors. We, therefore, prospectively assessed liver disease by etiology and severity in a cross-sectional cohort of people with SMI at a tertiary health service.

Methods

We recruited 255 people with SMI between August 2019 and March 2020. Liver disease data were derived from structured interview, medical records, biochemical and BBV serological analyses, and vibration-controlled transient elastography (VCTE). Steatosis was determined using a threshold of ≥ 248 db/m via the controlled attenuation parameter (CAP) on VCTE. Liver disease prevalence was assessed descriptively, and predictors of metabolic-dysfunction associated fatty liver disease (MAFLD) analyzed using linear regression and multivariable analysis. Best fit modeling of non-invasive screening tests for MAFLD was also assessed.

Results

Valid VCTE was obtained for 252 (98.9%) participants. Median age was 40 years (IQR 31–49) with male predominance (65.9%). Hepatitis C Virus (HCV) seroprevalence was 14.7% (37/252), with four new viremic cases identified. Hepatic steatosis was diagnosed in 61.5% (155/252) of participants, with MAFLD criteria met in 59.9% (151/252) of cases. Clozapine and paliperidone were associated with hepatic steatosis (CAP + 23.3 db/m, p 0.013 and CAP + 25.5, p 0.037, respectively). Advanced liver disease, defined by LSM ≥ 8.2 kPa, was identified in 26 individuals (10.3%). MAFLD compared to no MAFLD was associated with more advanced liver disease (5.3 kPa, 4.3–6.5 versus 4.9 kPa, 3.9–5.6, p < 0.001).

Conclusion

Liver disease is common in people with SMI and should be screened for as part of standard physical health assessment.

Graphic abstract

中文翻译：

严重精神疾病患者的肝病患病率和严重程度：使用非侵入性诊断工具的横断面分析

研究背景/目的

尽管风险因素增加，但对严重精神疾病 (SMI) 患者的全因肝病知之甚少。因此，我们在三级卫生服务机构的 SMI 患者横断面队列中，通过病因和严重程度前瞻性地评估了肝病。

方法

我们在 2019 年 8 月至 2020 年 3 月期间招募了 255 名 SMI 患者。肝病数据来自结构化访谈、医疗记录、生化和 BBV 血清学分析以及振动控制瞬时弹性成像 (VCTE)。通过 VCTE 上的受控衰减参数 (CAP)，使用 ≥ 248 db/m 的阈值确定脂肪变性。描述性评估肝病患病率，并使用线性回归和多变量分析分析代谢功能障碍相关脂肪肝 (MAFLD) 的预测因子。还评估了 MAFLD 非侵入性筛查测试的最佳拟合模型。

结果

252 (98.9%) 名参与者获得了有效的 VCTE。中位年龄为 40 岁 (IQR 31-49)，男性占优势 (65.9%)。丙型肝炎病毒 (HCV) 血清阳性率为 14.7% (37/252)，发现了四个新的病毒血症病例。61.5% (155/252) 的参与者被诊断为肝脂肪变性，59.9% (151/252) 的病例符合 MAFLD 标准。氯氮平和帕潘立酮与肝脂肪变性有关（分别为 CAP + 23.3 db/m，p = 0.013 和 CAP + 25.5，p = 0.037）。晚期肝病，定义为 LSM ≥ 8.2 kPa，在 26 人（10.3%）中被发现。与无 MAFLD 相比，MAFLD 与更晚期的肝病相关（5.3 kPa，4.3-6.5 对 4.9 kPa，3.9-5.6，p < 0.001）。