Lower levels of plasma NT-proBNP are associated with higher prevalence of NASH in patients with biopsy-proven NAFLD

https://doi.org/10.1016/j.numecd.2020.05.017Get rights and content

Highlights

  • The plasma NT-proBNP level is inversely associated with the prevalence of NASH.

  • The plasma NT-proBNP level is inversely associated with the NAS score.

  • Histological analysis according to the NAS system was used to diagnose NASH.

  • Lower plasma NT-proBNP levels could be used to discern NAFLD patients at risk of NASH.

Abstract

Background and aims

Emerging evidence suggests that plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are decreased in patients with imaging-defined nonalcoholic fatty liver disease (NAFLD), but no data are currently available on the association between plasma NT-proBNP levels and the histological severity of NAFLD.

Methods and results

We enrolled 351 (73.5% men) consecutive adult patients with biopsy-proven NAFLD without a prior history of cardiovascular disease (CVD). Plasma NT-proBNP levels were measured using a commercially available immunochemical system (VITROS® 5600, Johnson, New Jersey). Fifty-three percent of these subjects had nonalcoholic steatohepatitis (NASH). After stratification of patients by plasma NT-proBNP tertiles; compared to those in the 1st tertile (NT-proBNP ≤16 pg/ml), the odds ratio for NASH was 0.52 (95% CI 0.29–0.95) in patients in the 2nd tertile (NT-proBNP of 17–33 pg/ml) and 0.49 (95% CI 0.26–0.93) in those in the 3rd tertile (NT-proBNP ≥34 pg/ml) of plasma NT-proBNP levels, even after adjustment for age, sex, body mass index, homeostasis model assessment (HOMA)-estimated insulin resistance, pre-existing diabetes, hypertension, and dyslipidemia.

Conclusion

In subjects with biopsy-proven NAFLD without known CVD, this cross-sectional study shows for the first time, that lower plasma NT-proBNP levels are strongly associated with a higher prevalence of NASH.

Section snippets

Background

Nonalcoholic fatty liver disease (NAFLD) is defined as excessive accumulation of triglycerides in the liver without other competing causes of hepatic fatty infiltration. Nonalcoholic steatohepatitis (NASH) is the potentially progressive form of NAFLD that also increases the risk of developing cardiovascular disease (CVD) [1]. One of the major causes for the development of NAFLD is thought to be a compromised capacity to oxidize excess fatty acids in the liver [2]. Over time, chronic

Patients

We enrolled 351 adult individuals with biopsy-proven NAFLD, who did not have a prior history of CVD (defined by self-reported history, plasma NT-proBNP levels >200 pg/ml, or electrocardiographic changes suggestive of myocardial ischemia, or infarction). These patients were consecutively recruited between December 2016 and February 2019 at the First Affiliated Hospital of Wenzhou Medical University, from an investigator initiated study cohort [8]. Patients enrolled in the cohort were subject to

Baseline characteristics

A total of 351 consecutive patients with biopsy-proven NAFLD were included in this study. Table 1 shows the clinical and liver histological characteristics of patients stratified by plasma NT-proBNP tertiles. The age of participants increased significantly and the proportion of male sex decreased as plasma NT-proBNP level increased. There were significant differences in adiposity measures, fasting insulin levels, HOMA-IR score, and proportion of both diabetes and hypertension (but not

Discussion

We showed that lower plasma NT-proBNP levels are significantly associated with a higher prevalence of NASH in a large cohort of Chinese patients with biopsy-proven NAFLD who did not have a prior history of CVD. This association was independent of age, sex, HOMA-IR score, and features of the metabolic syndrome.

While other investigators have previously shown that plasma NT-proBNP levels were significantly decreased in individuals with magnetic resonance imaging or computed tomography-defined

Conclusion

This study showed for the first time that lower plasma NT-proBNP levels are significantly associated with higher prevalence of NASH and histological NAS score in middle-aged Chinese individuals with biopsy-confirmed NAFLD without a prior history of CVD. Notably, this association remained significant even after adjustment for age, sex, HOMA-estimated insulin resistance, pre-existing diabetes, dyslipidemia, and hypertension.

Financial grants and other funding

This work was supported by grants from the National Natural Science Foundation of China (81500665), High Level Creative Talents from Department of Public Health in Zhejiang Province, Project of New Century 551 Talent Nurturing in Wenzhou. GT is supported in part by grants from the University School of Medicine of Verona, Verona, Italy. CDB is supported in part by the Southampton NIHR Biomedical Research Centre (IS-BRC-20004), UK.

Informed consent

Informed consent was obtained from all participants in the study.

Ethics approval statement

Ethical approval for the study was obtained from the ethics committee of the First Affiliated Hospital of Wenzhou Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the ethical guidelines of the 1975 Declaration of Helsinki.

Declaration of Competing Interest

All authors do not have conflicts of interest to disclose.

Acknowledgments

None.

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