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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

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. AIM: To design a bespoke cardiovascular risk score in NAFLD. METHODS: A retrospective der...

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Autores principales: Abeles, Robin D., Mullish, Benjamin H., Forlano, Roberta, Kimhofer, Torben, Adler, Maciej, Tzallas, Alexandros, Giannakeas, Nikolaos, Yee, Michael, Mayet, Jamil, Goldin, Robert D., Thursz, Mark R., Manousou, Pinelopi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519040/
https://www.ncbi.nlm.nih.gov/pubmed/30836450
http://dx.doi.org/10.1111/apt.15192
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author Abeles, Robin D.
Mullish, Benjamin H.
Forlano, Roberta
Kimhofer, Torben
Adler, Maciej
Tzallas, Alexandros
Giannakeas, Nikolaos
Yee, Michael
Mayet, Jamil
Goldin, Robert D.
Thursz, Mark R.
Manousou, Pinelopi
author_facet Abeles, Robin D.
Mullish, Benjamin H.
Forlano, Roberta
Kimhofer, Torben
Adler, Maciej
Tzallas, Alexandros
Giannakeas, Nikolaos
Yee, Michael
Mayet, Jamil
Goldin, Robert D.
Thursz, Mark R.
Manousou, Pinelopi
author_sort Abeles, Robin D.
collection PubMed
description 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. AIM: 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 of MACE. The “NAFLD CV‐risk score” was generated using binary logistic regression: 0.06*(Age) + 0.963*(MPV) + 0.26*(DM(1)) – 16.44; (1)Diabetes mellitus: 1: present; 2: absent. (AUROC 0.84). A cut‐off of −3.98 gave a sensitivity 97%, specificity 27%, PPV 16%, and 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.
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spelling pubmed-65190402019-05-21 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 Abeles, Robin D. Mullish, Benjamin H. Forlano, Roberta Kimhofer, Torben Adler, Maciej Tzallas, Alexandros Giannakeas, Nikolaos Yee, Michael Mayet, Jamil Goldin, Robert D. Thursz, Mark R. Manousou, Pinelopi Aliment Pharmacol Ther Predicting Cardiovascular Events in Patients with Nafld 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. AIM: 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 of MACE. The “NAFLD CV‐risk score” was generated using binary logistic regression: 0.06*(Age) + 0.963*(MPV) + 0.26*(DM(1)) – 16.44; (1)Diabetes mellitus: 1: present; 2: absent. (AUROC 0.84). A cut‐off of −3.98 gave a sensitivity 97%, specificity 27%, PPV 16%, and 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. John Wiley and Sons Inc. 2019-03-05 2019-04 /pmc/articles/PMC6519040/ /pubmed/30836450 http://dx.doi.org/10.1111/apt.15192 Text en © 2019 The Authors. Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Predicting Cardiovascular Events in Patients with Nafld
Abeles, Robin D.
Mullish, Benjamin H.
Forlano, Roberta
Kimhofer, Torben
Adler, Maciej
Tzallas, Alexandros
Giannakeas, Nikolaos
Yee, Michael
Mayet, Jamil
Goldin, Robert D.
Thursz, Mark R.
Manousou, Pinelopi
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
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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Predicting Cardiovascular Events in Patients with Nafld
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519040/
https://www.ncbi.nlm.nih.gov/pubmed/30836450
http://dx.doi.org/10.1111/apt.15192
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