OP04 The association of haemoglobin levels with steatosis and fibrosis in non-alcoholic fatty liver disease, as determined by fibroscan

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in clinical practice. The literature suggests an association between Hb and NAFLD severity. We evaluated this association and potential confounders, using controlled attenuation parameter and transient elastography scores on FibroScan results. We also assessed whether BMI was a confounder.MethodsThis retrospective study included NAFLD-diagnosed adults in the trust between 30/10/2020–19/07/2021 meeting our predefined inclusion criteria. The cohort was evaluated for CAP and fibrosis scores, BMI, age, and blood parameters. Of 263 patients initially eligible, 59(22%) were excluded due to potential confounders on Hb, primarily haematological disease.Results204 patients were eligible for study inclusion. Participants with advanced fibrosis(>18.5kpa) were excluded as cirrhosis was thought likely to affect Hb levels. Amongst the remaining participants(n=196), there was a significant positive correlation between Hb and fibrosis(p=0.04). A stronger association was seen in women(p=0.005) than men(p=0.129). Hb was significantly correlated with steatosis(p=0.0144) (n=196). BMI was not associated with Hb in neither women(P=0.490) nor men(P=0.927).DiscussionAn association between Hb and NAFLD severity is variably reported within the literature. Our study showed an association between Hb and fibrosis amongst patients without advanced cirrhosis. Supporting this, an association was found between Hb and CAP score. The differences between men and women may be explained through imperfect alcohol histories and lack of dietary data. In addition, the post-menopausal age of our cohort would eliminate the protective effect of oestrogen presented in the literature. BMI was not associated with Hb suggesting that BMI was not a confounder and Hb was an independent predictor of NAFLD severity in patients without advanced liver disease.ConclusionThe correlation of CAP score with Hb suggests that NAFLD presence is linked to high Hb levels. This suggests the importance of evaluating the role of hypoxia in NAFLD pathogenesis and could warrant screening in patients with high Hb. This study showed that Hb was a predictor of fibrosis in women without advanced liver disease. Larger studies may be needed to evaluate this in men with improved alcohol testing and dietary recording. Testing Hb and fibrosis association in NAFLD will require a well-characterised cohort with exclusion of alcohol as an