Predictive Value Of Non-invasive Score System In Non-alcoholic Fatty Liver Disease Related Chronic Kidney Disease

ObjectTo compare the predictive value of the non-invasive score system in identifying prevelant CKD among individuals of NAFLD patients,and finding out the most suitable and valuable scoring system in identifing NAFLD related CKD.MethodsPatients who was diagnosed as NAFLD accoding to the guidelines for the diagnosis and treatment of Nonalcoholic fatty liver disease published by Chinese Medical Association form February 2013 to February 2017 in China-Japan union Hospital of Jilin University.Exclusion criteria include:(1)Patients who were younger than 20 years old or older than 80 years old.(2)NAFLD accompanied with malignant disease.(3)Patients with bile duct of liver inside and outside,infection of biliary tract disease.(4)history of useing of hepatotoxic or nephrotoxicity drugs within 3 months.(5)Metabolic disease known to induce liver damage,such as Wilson’s disease,hemochromatosis and gout.(6)Serious cardiovascular disease,including myocardial infarction,angina and heart failure.(7)Pregnancy or breast-feeding women.Calculating the eGFR of each patient according to the serum biochemical analysi,when eGFR in < 60 ml/min/1.73 m squared)was defined as chronic kidney disease.Participantswere divided into NAFLD group and NAFLD with CKD group accoding to the eGFR.Then scoring for the patients withNFS,FIB-4,BARD and APRI,and using the AUROC to estimatee the predictive value of the 4 non-invasive score system for CKD,an area under the ROC curve(AUROC)over 0.7 was considered clinically useful.Compareing the general characteristics of the two groups to get the indexs which was statistically different.Finding out the most suitable and valuable scoring system in identifing NAFLD related CKD,and using a multivariable logistic regression analysis to adjust for confounding factors,then acquiring the significant independent predictor of NAFLD related CKD.Result(1)The subjects with CKD were older than those without CKD(62.9±13.0 vs 51.1±13.2,p<0.05).The morbidity of diabetesmellitus in CKD was higher than those without CKD(40% vs 13.6%,p <0.05).Besides,the subjects with CKD also had higher creatinine than those without CKD(139.5±67.36 vs 74.8±13.9,p<0.05).Otherwise,they also had higher AST and GGT levels than those without CKD(p<0.05).(2)The sensitivity of the four non-invasive system was all above70%,and in which BARD was the highest gaving the sensitivity of86.77%.The NPV was all above 85%,and BARD was also the highest gaving the NPV of 90.71%.However,the specificity and PPV were around 50%.The AUROC was greatest for BARD(0.711),followed by NFS(0.703),FIB-4(0.634),APRI(0.619).(3)Age and BARD were also significant independent predictors of NAFLD related CKD after adjustment for age,gender,BMI,SBP,DBP,triglyceride,cholesterol,the OR was 2.82 when increasing one unit.Though,the area under ROC of NFS was 0.703,after adjustmentfor confounding factors,the OR was 0.83 when increasing one unit.Conclusion(1)High non-invasive fibrosis score is associated with anincreased risk of prevalent CKD.(2)BARD was most suitable and valuable scoring system in identifing NAFLD related CKD,and has high exclusion diagnosis value.