Catriona M Maybury1,2,3,4, Heather F Porter5, Ewa Kloczko1, Michael Duckworth2,3,4, Alice Cotton1, Kate Thornberry1, Tracy Dew6,7, Martin Crook8, Sarah Natas2,3,4, Rosa Miquel9, Cathryn M Lewis5,10, Terry Wong2,3,4, Catherine H Smith1,2,3,4, Jonathan N Barker1. 1. St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom. 2. Department of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, Great Maze Pond, London, United Kingdom. 3. Department of Radiology, Guy's and St Thomas' National Health Service Foundation Trust, Great Maze Pond, London, United Kingdom. 4. Department of Hepatology, Guy's and St Thomas' National Health Service Foundation Trust, Great Maze Pond, London, United Kingdom. 5. Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 6. Contract Research Laboratory, Viapath, King's College Hospital, Denmark Hill, London, United Kingdom. 7. Affinity Biomarker Labs, London, United Kingdom. 8. Department of Chemical Pathology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. 9. Liver Histopathology Laboratory, Institute of Liver Studies, King's College Hospital, London, United Kingdom. 10. Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, United Kingdom.
Abstract
IMPORTANCE: Advanced liver fibrosis is a precursor to cirrhosis, a leading cause of mortality. People with severe psoriasis are at risk for liver disease, but our understanding of advanced fibrosis in individuals with psoriasis is limited. OBJECTIVES: To describe the prevalence of and evaluate the clinical factors associated with advanced liver fibrosis in people with severe psoriasis. DESIGN, SETTING, AND PARTICIPANTS: The Co-morbidities in Severe Psoriasis study, a prospective observational cohort study in a large center serving London and Southeast England, was conducted from October 18, 2012, to April 2, 2015; 400 adults with severe psoriasis (Psoriasis Area Severity Index score, ≥10) were recruited from outpatient clinics. Statistical analysis was conducted from October 2, 2016, to March 3, 2017. MAIN OUTCOMES AND MEASURES: The primary outcome was a diagnosis of advanced liver fibrosis determined by transient elastography, a noninvasive criterion standard test. Clinical factors evaluated included psoriasis-specific and metabolic indices, alcohol use, and methotrexate exposure. RESULTS: Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5 [13] years), 333 had a successful transient elastography scan and were included in final analysis. Forty-seven patients (14.1%; 95% CI, 10.4%-17.9%) had advanced liver fibrosis as diagnosed by transient elastography. The clinical factors that produced the best-fit model for advanced fibrosis were central obesity (waist circumference), insulin resistance, aspartate aminotransferase level, platelet count, psoriasis disease severity, and reduced alcohol use (R2 = 0.54). CONCLUSIONS AND RELEVANCE: Findings from this study suggest that advanced fibrosis is common in severe psoriasis. Abdominal obesity (by waist circumference) and insulin resistance were associated with the presence of advanced fibrosis. Longitudinal work to characterize the hepatic sequelae of central obesity, insulin resistance, and inflammation as well as the influence of systemic drugs (methotrexate and biologics) will inform future personalized therapeutic decision-making. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02174367.
IMPORTANCE: Advanced liver fibrosis is a precursor to cirrhosis, a leading cause of mortality. People with severe psoriasis are at risk for liver disease, but our understanding of advanced fibrosis in individuals with psoriasis is limited. OBJECTIVES: To describe the prevalence of and evaluate the clinical factors associated with advanced liver fibrosis in people with severe psoriasis. DESIGN, SETTING, AND PARTICIPANTS: The Co-morbidities in Severe Psoriasis study, a prospective observational cohort study in a large center serving London and Southeast England, was conducted from October 18, 2012, to April 2, 2015; 400 adults with severe psoriasis (Psoriasis Area Severity Index score, ≥10) were recruited from outpatient clinics. Statistical analysis was conducted from October 2, 2016, to March 3, 2017. MAIN OUTCOMES AND MEASURES: The primary outcome was a diagnosis of advanced liver fibrosis determined by transient elastography, a noninvasive criterion standard test. Clinical factors evaluated included psoriasis-specific and metabolic indices, alcohol use, and methotrexate exposure. RESULTS: Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5 [13] years), 333 had a successful transient elastography scan and were included in final analysis. Forty-seven patients (14.1%; 95% CI, 10.4%-17.9%) had advanced liver fibrosis as diagnosed by transient elastography. The clinical factors that produced the best-fit model for advanced fibrosis were central obesity (waist circumference), insulin resistance, aspartate aminotransferase level, platelet count, psoriasis disease severity, and reduced alcohol use (R2 = 0.54). CONCLUSIONS AND RELEVANCE: Findings from this study suggest that advanced fibrosis is common in severe psoriasis. Abdominal obesity (by waist circumference) and insulin resistance were associated with the presence of advanced fibrosis. Longitudinal work to characterize the hepatic sequelae of central obesity, insulin resistance, and inflammation as well as the influence of systemic drugs (methotrexate and biologics) will inform future personalized therapeutic decision-making. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02174367.
Authors: Kevin Sheng-Kai Ma; Chee-Ming Lee; Po-Hung Chen; Yan Yang; Yi Wei Dong; Yu-Hsun Wang; James Cheng-Chung Wei; Wen Jie Zheng Journal: Front Med (Lausanne) Date: 2022-06-13