Abstract
Background: Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD). Methods: We analysed individuals enrolled in the ongoing prospective population-based Rotterdam Study who attended a visit between 2009–2014 that included liver stiffness measurement. Exclusion criteria for the primary analysis were incomplete data on heart failure, unreliable liver stiffness, alcohol abuse and viral hepatitis, leaving 4.153 participants (aged 67.5 ± 8.4 years, 44.2% male) for analysis with a median follow-up of 6.0 (interquartile range: 5.1–7.0) years. Secondary analysis included participants with viral hepatitis, alcohol abuse and/or unreliable measurement. The association between liver stiffness and mortality was assessed using Cox regression. Associations between heart failure, CHD, and echocardiographic characteristics and liver stiffness were quantified with linear regression. Results: Liver stiffness ≥8.0 kPa was associated with mortality (aHR: 1.37, 95%CI: 1.00–1.89). However, this was driven by participants with heart failure (aHR: 2.48, 95%CI: 1.15–5.35), since high liver stiffness was not associated with mortality in participants without heart failure and/or CHD (aHR: 1.07, 95%CI: 0.70–1.64). Results were consistent when individuals with viral hepatitis, alcohol abuse or unreliable liver stiffness measurement were not excluded. Several cardiovascular characteristics were significantly associated with higher liver stiffness, e.g. heart failure, moderate/poor diastolic dysfunction, and right atrium diameter > 4.5 cm. Conclusion: In our cohort of community-dwelling elderly, high liver stiffness was associated with excess mortality, primarily explained by participants with heart failure. Moreover, heart failure and its indicators were associated with increased liver stiffness.
| Original language | English |
|---|---|
| Pages (from-to) | 1000-1007 |
| Number of pages | 8 |
| Journal | Liver International |
| Volume | 43 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - May 2023 |
Bibliographical note
Funding Information:The Rotterdam Study is funded by the Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands, the Organization for the Health Research and Development (ZonMw), the Research institute for Diseases in the Elderly (Ride), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII) and the Municipality of Rotterdam. Financial support was also provided by the Foundation for Liver and Gastrointestinal Research, Rotterdam, the Netherlands. The funding sources did not influence study design, data collection, analysis and interpretation of the data, nor the writing of the report and decision to submit for publication.
Funding Information:
MJS has received speaker's fees and research support from Fujirebio and received grants from Gilead and Fujirebio. RdK is a speaker for Echosens, consultant for AbbVie and received grants from Abbvie, Gilead and Janssen. The other authors had no conflicts of interest.
Publisher Copyright:
© 2023 The Authors. Liver International published by John Wiley & Sons Ltd.
