Publication: Mo174fibroscan detection of fatty liver and liver fibrosis in systemic lupus erythematosus
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Date
2021-05-01
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Abstract
BACKGROUND AND AIMS: Systemic Lupus Erythematosus (SLE) is a chronic,
multi-organ, systemic autoimmune disease that is more common in women than men
and is typically diagnosed during the reproductive age. Although liver dysfunction is
not considered the main organ pathology in SLE, the frequency of liver dysfunction or
abnormal liver enzyme values may be observed in 50-60% of patients. Liver-related
complications may present as asymptomatic hepatomegaly, subclinical steatosis and
abnormal liver enzymes. The most common causes are drug-associated liver injury,
lupus-associated hepatitis, and fatty liver disease. The aim of this study was to assess
fatty liver and liver fibrosis in SLE patients using the FibroScan method as well as
associated factors such as immunosuppressive medications.
METHOD: Sixty SLE patients and 30 healthy controls were included. Patients with
HBV, HCV or cirrhosis, malignancy, cardiac disease, or patients on dialysis were
excluded. All participants underwent FibroScan measurements. Demographic data and
cumulative doses of immunosuppressive medications were extracted from patient
charts. Fasting blood was collected for analysis
RESULTS: Demographic and clinical characteristics of the study groups are shown in
Tables 1. The prevalence of fatty liver disease was similar between SLE patients and
healthy controls (21.7% vs 26.7%, p= 0.597) and was associated with body mass index
(BMI) (p= 0.026) and C-reactive protein (CRP) (p= 0.046) in multivariate analysis.
Liver fibrosis was also similar between the two groups (26.7% vs 10.0%, p= 0.069).
There was no relationship between cumulative drug doses including glucocorticoids
with either fatty liver disease or liver fibrosis. Since the majority of SLE patients were
female, we performed a subgroup analysis in female patients (n=51) and healthy
controls (n=25). Fatty liver disease was similar between female SLE patients and
healthy controls (23.5% vs 24.0%, p= 0.964). However, liver fibrosis in female patients
with SLE was increased compared to the female healthy population (29.4% vs 4.0%, p=
0.011) and was associated with age (p= 0.034) and low-dose cumulative glucocorticoid
use (p = 0.034). Low-dose cumulative glucocorticoid use was defined as less than 17.45
g, which was the 75th percentile value. Only 1 out of 15 female patients with fibrosis
had high-dose cumulative glucocorticoid use (>17.45 g), while the remaining 14
patients had used lower doses (<17.45 g).
CONCLUSION: The prevalence of fatty liver was similar between SLE patients and
healthy controls, while liver fibrosis was increased in the female patient group as
compared to controls. Furthermore, liver fibrosis was associated with age and low dose
cumulative glucocorticoid use. Interestingly, fatty liver did not precede liver fibrosis in
the majority of cases, contrary to what is observed in the general population. We
hypothesized that liver fibrosis may be the result of subclinical inflammation and
autoimmunity associated with SLE itself and the use of steroids may prevent or prolong
fibrosis formation in the liver.
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Yetginoğlu Ö., BARUTÇU ATAŞ D., VELİOĞLU A., ARIKAN İ. H., YILMAZ Y., ALİBAZ ÖNER F., DİRESKENELİ R. H., TUĞLULAR Z. S., AŞICIOĞLU E., \"MO174FIBROSCAN DETECTION OF FATTY LIVER AND LIVER FIBROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS\", 58th ERA-EDTA congress fully virtual June 5-8 2021, Almanya, 5 - 08 Haziran 2021, cilt.36, ss.172