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Derivation and validation of a cardiovascular risk score for prediction of major acute cardiovascular events in non-alcoholic fatty liver disease; the importance of an elevated mean platelet volume

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Title: Derivation and validation of a cardiovascular risk score for prediction of major acute cardiovascular events in non-alcoholic fatty liver disease; the importance of an elevated mean platelet volume
Authors: Abeles, RD
Mullish, BH
Forlano, R
Kimhofer, T
Adler, M
Tzallas, A
Giannakeas, N
Yee, M
Mayet, J
Goldin, RD
Thursz, MR
Manousou, P
Item Type: Journal Article
Abstract: Background: Atherosclerotic cardiovascular disease is a key cause of morbidity in non-alcoholic fatty liver disease (NAFLD) but appropriate means to predict major acute cardiovascular events (MACE) are lacking. Aims: To design a bespoke cardiovascular risk score in NAFLD. Methods: A retrospective derivation (2008-2016, 356 patients) and a prospective validation (2016- 2017, 111 patients) NAFLD cohort study was performed. Clinical and biochemical data were recorded at enrolment and mean platelet volume (MPV), Qrisk2 and Framingham scores were recorded one year prior to MACE (Cardiovascular death, acute coronary syndrome, stroke, and transient ischaemic attack). Results: The derivation and validation cohorts were well matched with MACE prevalence 12.6% and 12% respectively. On univariate analysis, age, diabetes, advanced fibrosis, collagen proportionate area >5%, MPV and liver stiffness were associated with MACE. After multivariate analysis, age, diabetes and MPV remained independently predictive. The ‘NAFLD CV-risk score’ was generated using binary logistic regression: 85860.06*(Age) + 0.963*(MPV) + 0.26*(DM1) – 16.441 Diabetes mellitus: 1: present; 2: absent. (AUROC 0.84). A cut-off of -3.98 gave a Sensitivity 97%, Specificity 27%, PPV 16%, NPV 99%. An MPV alone of >10.05 gave a sensitivity 97%, specificity 59%, PPV 24% and NPV 97% (AUROC 0.83). Validation cohort AUROCs were comparable at 0.77 (NAFLD CV-risk) and 0.72 (MPV). In the full cohort, the NAFLD CV-risk score and MPV outperformed both Qrisk2 and Framingham scores. Conclusions: The NAFLD CV risk score and MPV accurately predict 1-year risk of MACE thereby allowing better identification of patients that require optimisation of their cardiovascular risk profile.
Issue Date: 5-Mar-2019
Date of Acceptance: 23-Jan-2019
URI: http://hdl.handle.net/10044/1/67225
DOI: 10.1111/apt.15192
ISSN: 0269-2813
Publisher: Wiley
Journal / Book Title: Alimentary Pharmacology and Therapeutics
Copyright Statement: This paper is embargoed until publication. Once published it will be available fully open access.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Medical Research Council
Medical Research Council (MRC)
European Association for the Study of Liver
Funder's Grant Number: RDA27
MR/R00875/1
MR/R000875/1
N/A
Keywords: 1103 Clinical Sciences
1115 Pharmacology And Pharmaceutical Sciences
Gastroenterology & Hepatology
Publication Status: Accepted
Embargo Date: publication subject to indefinite embargo
Appears in Collections:Division of Surgery
National Heart and Lung Institute
Faculty of Medicine



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