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. 2022 Jun 23:9:848121.
doi: 10.3389/fcvm.2022.848121. eCollection 2022.

Fatty Liver Index Independently Predicts All-Cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis but No Substantial Liver Disease

Pil Gyu Park  1 , Jung Yoon Pyo  1 , Sung Soo Ahn  1 , Hyun Joon Choi  2 , Jason Jungsik Song  1   3 , Yong-Beom Park  1   3 , Ji Hye Huh  4 , Sang-Won Lee  1   3
Affiliations

Fatty Liver Index Independently Predicts All-Cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis but No Substantial Liver Disease

Pil Gyu Park et al. Front Cardiovasc Med. .

Abstract

Background: This study investigated whether the fatty liver index (FLI) could predict all-cause mortality and cerebrovascular accident (CVA) during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) without substantial liver disease.

Methods: The medical records of 75 AAV patients with AAV were retrospectively reviewed. An equation for the FLI is as follows: FLI = (e0.953×loge(triglycerides)+0.139×BMI+0.718×loge(GGT)+0.053×waistcircumference-15.745)/(1 + e0.953×loge(triglycerides)+0.139×BMI+0.718×loge(GGT)+0.053×waistcircumference-15.745) × 100. The cut-offs of the FLI were obtained using the receiver operator characteristic (ROC) curve analysis.

Results: The mean age at AAV diagnosis was 59.1 years and 42.7% were male. Eight patients (10.7%) died and 8 patients had CVA during follow-up. When the cut-offs of the FLI for all-cause mortality and CVA were set as the FLI ≥ 33.59 and the FLI ≥ 32.31, AAV patients with the FLI over each cut-off exhibited a higher risk for all-cause mortality or CVA than those without (RR 8.633 and 8.129), respectively. In addition, AAV patients with the FLI over each cut-off exhibited a significantly lower cumulative patients' survival rate or CVA-free survival rate than those without, respectively. In the multivariable Cox analysis, only the FLI ≥ 33.59 at AAV diagnosis was an independent predictor of all-cause mortality during follow-up in AAV patients (HR 10.448).

Conclusion: The FLI at AAV diagnosis can be a potential independent predictor of all-cause mortality and CVA during follow-up in AAV patients. We suggest that physicians measure the FLI at AAV diagnosis and pay more attention to those with a high FLI value for prevention of future mortality and CVA.

Keywords: antineutrophil cytoplasmic antibody; cerebrovascular accident; fatty liver index; mortality; vasculitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Cut-offs of the FLI for all-cause mortality and CVA. (A) Identification of the cut-off of the FLI for all-cause mortality using the ROC curve. (B) RR of all-cause mortality according to the cut-off of the FLI. (C) Identification of the cut-off of the FLI for CVA using the ROC curve. (D) RR of CVA based on the cut-off of the FLI. (E,F) Identification of the cut-offs of the FLI for ESRD and CVD. FLI, fatty liver index; RR, relative risk; CVA, cerebrovascular accident; ROC, receiver operator characteristic; ESRD, end-stage renal disease; CVD, cardiovascular disease.
FIGURE 2
FIGURE 2
Comparison of cumulative survival rates. AAV patients with the FLI ≥ 33.59 and that ≥ 32.31 at diagnosis exhibited significantly lower cumulative patients’ and CVA-free survival rates than those without, respectively. AAV, ANCA-associated vasculitis; ANCA, antineutrophil cytoplasmic antibody; FLI, fatty liver index; CVA, cerebrovascular accident.
FIGURE 3
FIGURE 3
A hypothesis of the mechanism. AAV, ANCA-associated vasculitis; ANCA, antineutrophil cytoplasmic antibody; IR, insulin resistance; FLI, fatty liver index; NAFLD, non-alcoholic fatty liver disease; CVA, cerebrovascular accident.
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