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Multicenter Study
. 2019 Dec 31:14:3053-3061.
doi: 10.2147/COPD.S233834. eCollection 2019.

Low Liver Density Is Linked to Cardiovascular Comorbidity in COPD: An ECLIPSE Cohort Analysis

Damien Viglino #  1   2 , Mickaël Martin #  1 , Natalie Almeras  1 , Jean-Pierre Després  1 , Harvey O Coxson  3 , Jean-Louis Pépin  2 , Isabelle Vivodtzev  2 , François Maltais  1 ; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigators
Affiliations
Multicenter Study

Low Liver Density Is Linked to Cardiovascular Comorbidity in COPD: An ECLIPSE Cohort Analysis

Damien Viglino et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Fatty liver disease is associated with cardiometabolic disorders and represents a potential key comorbidity in Chronic Obstructive Pulmonary Disease (COPD). Some intermediary mechanisms of fatty liver disease (including its histological component steatosis) include tissue hypoxia, low-grade inflammation and oxidative stress that are key features of COPD. Despite these shared physiological pathways, the effect of COPD on the prevalence of hepatic steatosis, and the association between hepatic steatosis and comorbidities in this population remain unclear. Liver density measured by computed tomography (CT)-scan is a non-invasive surrogate of fat infiltration, with lower liver densities reflecting more fat infiltration and a liver density of 40 Hounsfield Units (HU) corresponding to a severe 30% fat infiltration.

Patients and methods: We took advantage of the international cohort ECLIPSE in which non-enhanced chest CT-scans were obtained in 1554 patients with COPD and 387 healthy controls to analyse the liver density at T12-L1.

Results: The distribution of liver density was similar and the prevalence of severe steatosis (density<40 HU) was not different (4.7% vs 5.2%, p=0.7) between COPD and controls. In patients with COPD, the lowest liver density quartile was associated, after age and sex adjustment, with coronary artery disease (ORa=1.59, 95% CI 1.12 to 2.24) and stroke (ORa=2.20, 95% CI 1.07 to 4.50), in comparison with the highest liver density quartile.

Conclusion: The present data indicate that a low liver density emerged as a predictor of cardiovascular comorbidities in the COPD population. However, the distribution of liver density and the prevalence of severe steatosis were similar in patients with COPD and control subjects.

Keywords: ECLIPSE cohort; cardiovascular comorbidity; chest CT-scan; chronic obstructive pulmonary disease; fatty liver disease; liver density; steatosis.

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Conflict of interest statement

MM, NA and IV have no conflicts of interest to declare. DV reports research grants from Astra Zeneca outside the submitted work. JPD reports personal fees from Abbott Laboratories, AstraZeneca, Sanofi, GSK, Torrent Pharmaceuticals Ltd., Merck and Pfizer Canada Inc., outside the submitted work. HOC reports personal fees and grants from GSK during the conduct of the original ECLIPSE study and no other conflicts during the present study. JLP reports a grant from a consortium of homecare providers (ADIR assistance, Agiradom, IPS, ISIS Medical, LINDE, LVL Medical, SOS Oxygen and Vitalaire) and CPAP companies (Bréas, Philips, Resmed and Sefam), grants from Air Liquide Foundation, Astra-Zeneca, Mutualia, Philips, RESMED, Fisher and Paykel, and personal fees from JAZZ, ITAMAR, Perimetre, Philips, Fisher and Paykel, RESMED, Astra-Zeneca, SEFAM, Agiradom, ELIA and Teva outside the submitted work. FM reports grants and personal fees from Boehringer Ingelheim and GSK, grants from Nycomed and AstraZeneca, and grants and personal fees from Novartis and Grifols outside the submitted work. All fees are pooled with other revenues of the group of pulmonologists to which FM is a member and then shared among members of the group. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Example of a computed tomography slice before (Panel A) and after segmentation (Panel B).
Figure 2
Figure 2
Liver attenuation distribution among patients with COPD and control subjects. p>0.05 for all comparisons. Abbreviation: COPD, chronic obstructive pulmonary disease
Figure 3
Figure 3
Unadjusted and adjusted odds ratios to present cardiovascular comorbidity in the lowest liver density quartile vs the highest liver density quartile.
Figure 4
Figure 4
Inflammatory marker levels showing differences according to liver attenuation groups (A-D). Values are expressed with mean ± standard errors. 1 is the group with the lowest liver attenuation and 4 the group with the greatest liver attenuation. p-value for ANCOVA corrected for age, sex, Body Mass Index and smoking status. Abbreviations: CRP, C-reactive protein; IL6, and interleukin-6.
See this image and copyright information in PMC

References

    1. Lee -CT-C, Mao I-C, Lin C-H, Lin S-H, Hsieh M-C. Chronic obstructive pulmonary disease: a risk factor for type 2 diabetes: a nationwide population-based study. Eur J Clin Invest. 2013;43(11):1113–1119. doi:10.1111/eci.12147 - DOI - PubMed
    1. Onishi K. Total management of chronic obstructive pulmonary disease (COPD) as an independent risk factor for cardiovascular disease. J Cardiol. 2017;70(2):128–134. doi:10.1016/j.jjcc.2017.03.001 - DOI - PubMed
    1. Pistelli R, Lange P, Miller DL. Determinants of prognosis of COPD in the elderly: mucus hypersecretion, infections, cardiovascular comorbidity. Eur Respir J Suppl. 2003;40:10s–14s. doi:10.1183/09031936.03.00403403 - DOI - PubMed
    1. Huiart L, Ernst P, Suissa S. Cardiovascular morbidity and mortality in COPD. Chest. 2005;128(4):2640–2646. doi:10.1378/chest.128.4.2640 - DOI - PubMed
    1. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J. 2006;28(6):1245–1257. doi:10.1183/09031936.00133805 - DOI - PubMed

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