Serum high-sensitive C-reactive protein is a simple indicator for all-cause among individuals with MAFLD

Abstract

High-sensitive C-reactive protein (hs-CRP) is one of the diagnostic components for metabolic (-dysfunction) associated fatty liver disease (MAFLD). This study aimed to explore the relationship between hs-CRP level and 25-year mortality in patients with MAFLD. The study data were from the Third National Health and Nutrition Examination Survey 1988–1994. All participants were followed up until December 2015 and the outcome of each participant was ascertained from National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) of all-cause mortality, cardiovascular-related mortality, and malignancy-related mortality. A total of 4,145 participants with MAFLD were included in final analysis. The median follow-up period was 22.3 years (interquartile range 16.9–24.2). There were 1,610 (38.8%) all-cause deaths. The leading cause of death was malignant neoplasms (365/1,610, 22.7%), followed by cardiovascular diseases (342/1,610, 21.2%). Of the 4,145 patients with MAFLD, 1,293 (31.2%) had an hs-CRP level greater than 0.5 mg/dl. Those with hs-CRP > 0.5 mg/dl were older, more likely to be female and had greater derangements of metabolic profiles than those with lower hs-CRP. The results of Cox regression analysis showed that hs-CRP ≥ 0.5 mg/dl was an independent risk factor for all-cause mortality (HR = 1.394, 95% CI 1.253–1.551), cardiovascular mortality (HR = 1.497, 95% CI 1.190–1.885) and malignant neoplasms related mortality (HR = 1.290, 95% CI 1.030–1.615) after adjusting for risk factors. This study confirms that hs-CRP is an independent predictive factor of poor prognosis in patients with MAFLD.

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…Some early dampened CRP responses post-liver resection can reflect a poor hepatic reserve that could have prognostic value [ 340 ]. Importantly, a study demonstrated that increased hsCRP titers were linked to an increased risk of Metabolic-dysfunction Associated Fatty Liver Disease (MAFLD) in obese individuals, and it was also positively associated with the severity of liver steatosis and fibrosis; therefore, it may be used as a possible biomarker to monitor and estimate disease severity, while another study concluded that hsCRP can be an independent predictor of poor prognosis—even fatal outcomes—in MAFLD patients [ 341 , 342 ]. Interestingly, a study on rats showed that increased CRP levels can be an early sign of Alcoholic Fatty Liver (AFL), whereas another study concluded that CRP seems to be an accurate marker of alcoholic hepatitis [ 343 , 344 ].…”

Risk Scores for Prediction of Major Cardiovascular Events in Non-Alcoholic Fatty Liver Disease: A No Man’s Land?

“…According to the findings of a Cox regression analysis, hs-CRP levels below 0.5 mg/dL are an independent risk factor for mortality from all causes, cardiovascular disease, and malignancy. Hs-CRP could successfully differentiate MAFLD with poor prognosis and mortality risk at a level of 0.5 mg/dL [69,70]. Higher fibrosis grades were seen in patients with abnormal angiography according to a cross-sectional comparative investigation of 103 consecutive NAFLD patients by Nayebi et al, which revealed a significant difference in the level of hs-CRP according to elastography fibrosis grade [71].…”

“…Additionally, we are aware that these risk assessment models frequently do not take into consideration a number of the important CV disease risk factors, such as IR, obesity, and increased triglycerides. It has already been argued that the Framingham risk score understates the risk of CV disease in this population due to the similarities between metabolic syndrome and NAFLD [69,70]. As a result, it may not be appropriate to risk-stratify individuals with NAFLD solely based on the most recent CV risk score systems.…”

“…Several widely used tests are available with different degrees of accuracy to assess the presence of liver steatosis and fibrosis (Table 2). Hepatic steatosis is the mildest type of MAFLD/NAFLD, with a lipid content in the hepatic parenchyma of more than 5% and no portal or lobular inflammation [69,70,81]. In their lifetimes, approximately 4% of people with liver steatosis are anticipated to develop fibrosis [15,69,70].…”

“…Hepatic steatosis is the mildest type of MAFLD/NAFLD, with a lipid content in the hepatic parenchyma of more than 5% and no portal or lobular inflammation [69,70,81]. In their lifetimes, approximately 4% of people with liver steatosis are anticipated to develop fibrosis [15,69,70].…”