Relationship Between Non-alcoholic Fatty Liver Disease And Hematocrit And Prognosis Of Patients With Non-alcoholic Fatty Liver Disease

Background & aims Non-alcoholic fatty liver disease(NAFLD)is a clinical pathological syndrome associated with metabolic disorders of blood glucose and lipids and cardiovascular disease that is recognized a hepatic manifestation of metabolic syndrome.Hematocrit(HCT)is the most important determinant of blood flow.An increase in the HCT level affects blood flow to tissues and organs and materials transport clearly.Researchers have discovered an increase in the HCT level is closely associated with insulin resistance,cardiovascular disease and metabolic disturbance of blood lipids.Recently several studies have demonstrated a relationship between HCT and NAFLD.An increased risk for developing NAFLD is going up with an elevated HCT.Moreover,HCT level is positively correlated with pathological scoring of liver biopsy.Because of the opposite less in related research,the aim of the first part of this paper investigated relationship between HCT and NAFLD to provide new clinical parameters for pathogenesis,risk factors and evaluating severity of NAFLD.With the increasing prevalence of obesity,diabetes,and the metabolic syndrome(MS),NAFLD has become the most common cause of chronic liver disease.Knowledge of the prognosis of NAFLD and the factors that impact outcome have vital clinical significance.Several studies have showed the prognosis of NAFLD is strongly linked with its severity.The prognosis of simple non-alcoholic fatty liver disease(SS)is relatively benign and nonalcoholic steatohepatitis(NASH)can progress to end-stage liver disease including hepatic fibrosis,hepatic cirrhosis and hepatocellular carcinoma.Moreover,that survival of NASH patients is lower than the expected survival in the general population.Other studies reported there was no obvious difference between the survival and the causes of death of patients with NAFLD and those of the general population.Because results from studies on the prognosis of NAFLD have been inconsistent and researches of Chinese in the field are limited.The second part of this paper investigated prevalence,morbidity,prognosis and respective influencing factors of these objects by analyzing information of physical examination of retired veteran cadres and staffs of partial units in Shanghai retrospectively.Design Study of relationship between NAFLD and hematocrit Three hundred forty nine NAFLD patients and 349 controls from the healthy physical examinees in Shanghai Changzheng hospital during March to August 2015 were enrolled according to the inclusion and exclusion criteria.Datum of participants including smoking,alcohol consumption,clinical history,height,weight,blood pressure,laboratory variables,abdominal imaging results were collected.The difference in clinical datum was compared between two groups and the risk factors of developing NAFLD analysis were performed.NAFLD and controls groups were divided into groups according to quartile of HCT respectively,and the association between alanine aminotransferase(ALT)and HCT levels were analyzed in a dose response manner.The association between NAFLD with an increase in ALT level and HCT was performed further.Prevalence of NAFLD and its prognostic factors In this part of study,459 NAFLD patients diagnosed before 2012 and 374 controls without liver or biliary disease from retired cadres and staff members undergoing physical examination in Shanghai Changzheng hospital and Shanghai 85 hospital before December 31,2011 and receiving follow-up visits in either hospital every year since then were retrospectively enrolled according to the inclusion and exclusion criteria.Basic information,blood tests,abdominal ultrasound results collected by searching with unique physical examine number and smoking statues,drinking statues underwent a face-to-face interview were recorded.NAFLD patients were classified into three levels according to NAFLD with an increase in ALT level and(or)MS or not: one level—simple NAFLD,two level—NAFLD with MS and(or)higher ALT.Prognosis of NAFLD were divided into three states: stability—levels unchanged,aggravation—increasing one level,improvement—lowering one level or fatty liver disappeared.Difference of clinical parameters between two groups,prevalence,morbidity,prognosis,mortality,and respective influencing factors of objects of two groups were clarified.Results Study of relationship between NAFLD and hematocrit Compared with people without hepatic steatosis,participants with NAFLD had significantly higher levels of body mass index(BMI),systolic pressure,diastolic pressure,hematocrit,ALT,aspartate aminotransferase,fasting glucose,serum acid uric,triglycerides,low-density lipoprotein(LDL-C)and a lower level of high-density lipoprotein(HDL-C).NAFLD patients were more likely to be current smokers and to have a high MS.Binary logistic regression analysis implicated BMI,HCT,fasting glucose,triglycerides as independent factors associated with the presence of hepatic steatosis.The decrease in the risk of NAFLD was related to the increase of total serum bilirubin level.NAFLD group were divided into groups according to quartile of HCT levels:Q1(<42.6%),Q2(42.6%-45.2%),Q3(45.2%-48.1%),Q4(>48.1%).The level of ALT was calculated according to quartile of hematocrit levels respectively: Q1(18.29±9.34U/L),Q2(24.32±10.65U/L),Q3(29.89±18.25 U/L),Q4(36.70±23.70 U/L).ALT level is positively related to HCT level.Control group were divided into groups according to the quartile of HCT levels: Q1(<40.25%),Q2(40.25%-44.0%),Q3(44.0%-46.85%),Q4(>46.85%).The level of ALT was calculated according to quartile of HCT levels respectively: Q1(13.58±5.26U/L),Q2(16.16±6.09 U/L),Q3(18.60±6.65U/L),Q4(21.43±10.21 U/L).The likelihood of the elevated ALT level was positively correlated with the rising of BMI,HCT and triglycerides.Prevalence of NAFLD and its prognostic factors 459 NAFLD patients and 374 controls without liver disease were retrospectively involved into this part of study.The percentage of NAFLD in participants of different gender and age were obviously different,and male NAFLD ratio is significantly higher than women.The prevalence of NAFLD of male patients increased with increasing age before fifty years old and showed up a downward trend after sixty.The peak age of NAFLD in male was 50–59 years.Likewise,the rate of NAFLD in female increased with age in most of the age stages but decreased in the elderly and the peak age of NAFLD in female was delayed to 60–69 years.The percentages of NAFLD between two groups were no visibly different.BMI,systolic pressure,diastolic pressure,ALT,fasting glucose,uric acid and triglyceride of NAFLD group is higher than the control group.However,HDL-C is lower than the control group obviously.NAFLD patients were more likely to be current smokers,men,to have a high hypertension,diabetes,MS,new-onset diabetes and new-onset MS.The data showed that the risk of NAFLD significantly increased with the elevated levels of BMI,ALT,fasting glucose,triglyceride,and the decreased levels of HDL-C.Among 374 controls,64 developed NAFLD at the end-point with a cumulative NAFLD incidence of 17.1%(64/374)and an annual incidence of 2.89%.The percentage of new-onset NAFLD in control group of different gender and age were no obviously distinct.BMI and triglyceride were independent risk factors for developing NAFLD.Among 459 NAFLD patients diagnosed before 2012,235(51.2%)remained unchanged,40(8.7%)improved,144(31.4%)fatty liver disappeared,40(8.7%)became worse at the end of following of 71 months(23-284 months).Further analysis showed that the risk factors in the development and prognosis of NAFLD patients were found to be BMI,triglyceride and uric acid.Mortality and causes of death had no obvious difference between the two groups.The major causes of death in NAFLD patients are malignant tumor and cardiovascular.Conclusion In conclusion,the results of the first part of this article showed that hematocrit and development of NAFLD were closely correlated.Moreover,hematocrit was an independent risk factor for NAFLD with an elevated level of ALT.The second part found the prognosis of patients with NAFLD was relatively optimum.The influencing factor for development and prognosis of NAFLD were closely related to BMI,triglyceride and blood uric acid.NAFLD patients mainly died of malignant tumors and cardiovascular disease,rather than the end-stage liver disease.