Preya Janubhai Patel1, Fabrina Hossain2, Leigh Ula Horsfall1, Xuan Banh3, Kelly Lee Hayward3, Suzanne Williams2, Tracey Johnson2, Nigel Neil Brown4, Nivene Saad5, Patricia Casarolli Valery6, Katharine Margaret Irvine7, Andrew Donald Clouston3, Katherine Anne Stuart8, Anthony William Russell9, Elizabeth Ellen Powell10. 1. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia. 2. Inala Primary Care, Brisbane, Australia. 3. Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia. 4. Pathology Queensland, Brisbane, Australia. 5. Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia. 6. QIMR Berghofer Medical Research Institute, Brisbane, Australia. 7. Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia; Mater Research, Translational Research Institute, The University of Queensland, Brisbane, Australia. 8. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia. 9. School of Medicine, University of Queensland, Brisbane, Australia; Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia. 10. Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Australia. Electronic address: e.powell@uq.edu.au.
Abstract
AIMS: To examine the relationship between steatosis quantified by controlled attenuation parameter (CAP) values and glycaemic/metabolic control. METHODS: 230 patients, recruited from an Endocrine clinic or primary care underwent routine Hepatology assessment, with liver stiffness measurements and simultaneous CAP. Multivariable logistic regression was performed to identify potential predictors of Metabolic Syndrome (MetS), HbA1c ≥ 7%, use of insulin, hypertriglyceridaemia and CAP ≥ 300 dB/m. RESULTS: Patients were 56.7 ± 12.3 years of age with a high prevalence of MetS (83.5%), T2DM (81.3%), and BMI ≥ 40 kg/m2 (18%). Median CAP score was 344 dB/m, ranging from 128 to 400 dB/m. BMI (aOR 1.140 95% CI 1.068-1.216), requirement for insulin (aOR 2.599 95% CI 1.212-5.575), and serum ALT (aOR 1.018 95% CI 1.004-1.033) were independently associated with CAP ≥ 300 dB/m. Patients with CAP interquartile range < 40 (68%) had a higher median serum ALT level (p = 0.029), greater prevalence of BMI ≥ 40 kg/m2 (p = 0.020) and higher median CAP score (p < 0.001). Patients with higher CAP scores were more likely to have MetS (aOR 1.011 95% CI 1.003-1.019), HBA1c ≥ 7 (aOR 1.010 95% CI 1.003-1.016), requirement for insulin (aOR 1.007 95% CI 1.002-1.013) and hypertriglyceridemia (aOR 1.007 95% CI 1.002-1.013). CONCLUSIONS: Our data demonstrate that an elevated CAP reflects suboptimal metabolic control. In diabetic patients with NAFLD, CAP may be a useful point-of-care test to identify patients at risk of poorly controlled metabolic comorbidities or advanced diabetes.
AIMS: To examine the relationship between steatosis quantified by controlled attenuation parameter (CAP) values and glycaemic/metabolic control. METHODS: 230 patients, recruited from an Endocrine clinic or primary care underwent routine Hepatology assessment, with liver stiffness measurements and simultaneous CAP. Multivariable logistic regression was performed to identify potential predictors of Metabolic Syndrome (MetS), HbA1c ≥ 7%, use of insulin, hypertriglyceridaemia and CAP ≥ 300 dB/m. RESULTS:Patients were 56.7 ± 12.3 years of age with a high prevalence of MetS (83.5%), T2DM (81.3%), and BMI ≥ 40 kg/m2 (18%). Median CAP score was 344 dB/m, ranging from 128 to 400 dB/m. BMI (aOR 1.140 95% CI 1.068-1.216), requirement for insulin (aOR 2.599 95% CI 1.212-5.575), and serum ALT (aOR 1.018 95% CI 1.004-1.033) were independently associated with CAP ≥ 300 dB/m. Patients with CAP interquartile range < 40 (68%) had a higher median serum ALT level (p = 0.029), greater prevalence of BMI ≥ 40 kg/m2 (p = 0.020) and higher median CAP score (p < 0.001). Patients with higher CAP scores were more likely to have MetS (aOR 1.011 95% CI 1.003-1.019), HBA1c ≥ 7 (aOR 1.010 95% CI 1.003-1.016), requirement for insulin (aOR 1.007 95% CI 1.002-1.013) and hypertriglyceridemia (aOR 1.007 95% CI 1.002-1.013). CONCLUSIONS: Our data demonstrate that an elevated CAP reflects suboptimal metabolic control. In diabeticpatients with NAFLD, CAP may be a useful point-of-care test to identify patients at risk of poorly controlled metabolic comorbidities or advanced diabetes.
Authors: David Brain; James O'Beirne; Ingrid J Hickman; Elizabeth E Powell; Patricia C Valery; Sanjeewa Kularatna; Ruth Tulleners; Alison Farrington; Leigh Horsfall; Adrian Barnett Journal: BMC Health Serv Res Date: 2020-04-21 Impact factor: 2.655