Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study
Background Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD). Methods We analysed indiv...
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| Veröffentlicht in: | Liver international 2023-05, Vol.43 (5), p.1000-1007 |
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| creator | Kleef, Laurens A. Sonneveld, Milan J. Zhu, Fang Ikram, M. Arfan Kavousi, Maryam Knegt, Robert J. |
| description | Background
Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD).
Methods
We analysed individuals enrolled in the ongoing prospective population‐based Rotterdam Study who attended a visit between 2009–2014 that included liver stiffness measurement. Exclusion criteria for the primary analysis were incomplete data on heart failure, unreliable liver stiffness, alcohol abuse and viral hepatitis, leaving 4.153 participants (aged 67.5 ± 8.4 years, 44.2% male) for analysis with a median follow‐up of 6.0 (interquartile range: 5.1–7.0) years. Secondary analysis included participants with viral hepatitis, alcohol abuse and/or unreliable measurement. The association between liver stiffness and mortality was assessed using Cox regression. Associations between heart failure, CHD, and echocardiographic characteristics and liver stiffness were quantified with linear regression.
Results
Liver stiffness ≥8.0 kPa was associated with mortality (aHR: 1.37, 95%CI: 1.00–1.89). However, this was driven by participants with heart failure (aHR: 2.48, 95%CI: 1.15–5.35), since high liver stiffness was not associated with mortality in participants without heart failure and/or CHD (aHR: 1.07, 95%CI: 0.70–1.64). Results were consistent when individuals with viral hepatitis, alcohol abuse or unreliable liver stiffness measurement were not excluded. Several cardiovascular characteristics were significantly associated with higher liver stiffness, e.g. heart failure, moderate/poor diastolic dysfunction, and right atrium diameter > 4.5 cm.
Conclusion
In our cohort of community‐dwelling elderly, high liver stiffness was associated with excess mortality, primarily explained by participants with heart failure. Moreover, heart failure and its indicators were associated with increased liver stiffness. |
| doi_str_mv | 10.1111/liv.15538 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2773720580</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2773720580</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3888-a9dd711c97cf5c601d0238b58db26d597a99501e35bfe259e155d6de92b76ca13</originalsourceid><addsrcrecordid>eNp1kc9LHDEUx0NpUWs99B-QQC_tYTU_NpOMtyKtFRYKrXoNmeSNG8lM1iSjnf71zbrWQ6G5vMD78OG990XoPSUntL7T4B9OqBBcvUIHdCnVgjNOX7_8Gd9Hb3O-I4S2raB7aJ83crlUtD1Av1f-ARLOxff9CDljn7HJOVpvCjj86Msawy-77QwxFRN8mbEfcVkDvoURkgl4EzdTMMXHEbtUdSPuZrwGkwrujQ9TgjN8VfkfsRRIzgz4Z5nc_A696U3IcPRcD9H11y9X598Wq-8Xl-efVwvLlVIL0zonKbWttL2wDaGOMK46oVzHGidaaepShAIXXQ9MtFAv4RoHLetkYw3lh-jjzrtJ8X6CXPTgs4UQzAhxyppJySUjQpGKfvgHvYtTGut0mikipFqyZiv8tKNsijkn6PUm-cGkWVOit4HoGoh-CqSyx8_GqRvAvZB_E6jA6Q549AHm_5v06vJmp_wD5BqWCg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2805784261</pqid></control><display><type>article</type><title>Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Kleef, Laurens A. ; Sonneveld, Milan J. ; Zhu, Fang ; Ikram, M. Arfan ; Kavousi, Maryam ; Knegt, Robert J.</creator><creatorcontrib>Kleef, Laurens A. ; Sonneveld, Milan J. ; Zhu, Fang ; Ikram, M. Arfan ; Kavousi, Maryam ; Knegt, Robert J.</creatorcontrib><description>Background
Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD).
Methods
We analysed individuals enrolled in the ongoing prospective population‐based Rotterdam Study who attended a visit between 2009–2014 that included liver stiffness measurement. Exclusion criteria for the primary analysis were incomplete data on heart failure, unreliable liver stiffness, alcohol abuse and viral hepatitis, leaving 4.153 participants (aged 67.5 ± 8.4 years, 44.2% male) for analysis with a median follow‐up of 6.0 (interquartile range: 5.1–7.0) years. Secondary analysis included participants with viral hepatitis, alcohol abuse and/or unreliable measurement. The association between liver stiffness and mortality was assessed using Cox regression. Associations between heart failure, CHD, and echocardiographic characteristics and liver stiffness were quantified with linear regression.
Results
Liver stiffness ≥8.0 kPa was associated with mortality (aHR: 1.37, 95%CI: 1.00–1.89). However, this was driven by participants with heart failure (aHR: 2.48, 95%CI: 1.15–5.35), since high liver stiffness was not associated with mortality in participants without heart failure and/or CHD (aHR: 1.07, 95%CI: 0.70–1.64). Results were consistent when individuals with viral hepatitis, alcohol abuse or unreliable liver stiffness measurement were not excluded. Several cardiovascular characteristics were significantly associated with higher liver stiffness, e.g. heart failure, moderate/poor diastolic dysfunction, and right atrium diameter > 4.5 cm.
Conclusion
In our cohort of community‐dwelling elderly, high liver stiffness was associated with excess mortality, primarily explained by participants with heart failure. Moreover, heart failure and its indicators were associated with increased liver stiffness.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.15538</identifier><identifier>PMID: 36744819</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Abuse ; Aged ; Alcohol ; Alcoholism ; Atria ; Cardiovascular disease ; Cardiovascular diseases ; Congestive heart failure ; Coronary artery disease ; Diameters ; Drug abuse ; Elasticity Imaging Techniques - methods ; epidemiology ; Failure analysis ; Female ; Fibrosis ; Heart diseases ; Heart failure ; Heart Failure - epidemiology ; Hepatitis ; Humans ; Liver ; Liver Cirrhosis ; Liver diseases ; liver stiffness ; Male ; Mortality ; Population studies ; Prospective Studies ; Secondary analysis ; Stiffness ; survival</subject><ispartof>Liver international, 2023-05, Vol.43 (5), p.1000-1007</ispartof><rights>2023 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2023 The Authors. Liver International published by John Wiley & Sons Ltd.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-a9dd711c97cf5c601d0238b58db26d597a99501e35bfe259e155d6de92b76ca13</citedby><cites>FETCH-LOGICAL-c3888-a9dd711c97cf5c601d0238b58db26d597a99501e35bfe259e155d6de92b76ca13</cites><orcidid>0000-0002-2333-1182</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fliv.15538$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fliv.15538$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36744819$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kleef, Laurens A.</creatorcontrib><creatorcontrib>Sonneveld, Milan J.</creatorcontrib><creatorcontrib>Zhu, Fang</creatorcontrib><creatorcontrib>Ikram, M. Arfan</creatorcontrib><creatorcontrib>Kavousi, Maryam</creatorcontrib><creatorcontrib>Knegt, Robert J.</creatorcontrib><title>Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background
Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD).
Methods
We analysed individuals enrolled in the ongoing prospective population‐based Rotterdam Study who attended a visit between 2009–2014 that included liver stiffness measurement. Exclusion criteria for the primary analysis were incomplete data on heart failure, unreliable liver stiffness, alcohol abuse and viral hepatitis, leaving 4.153 participants (aged 67.5 ± 8.4 years, 44.2% male) for analysis with a median follow‐up of 6.0 (interquartile range: 5.1–7.0) years. Secondary analysis included participants with viral hepatitis, alcohol abuse and/or unreliable measurement. The association between liver stiffness and mortality was assessed using Cox regression. Associations between heart failure, CHD, and echocardiographic characteristics and liver stiffness were quantified with linear regression.
Results
Liver stiffness ≥8.0 kPa was associated with mortality (aHR: 1.37, 95%CI: 1.00–1.89). However, this was driven by participants with heart failure (aHR: 2.48, 95%CI: 1.15–5.35), since high liver stiffness was not associated with mortality in participants without heart failure and/or CHD (aHR: 1.07, 95%CI: 0.70–1.64). Results were consistent when individuals with viral hepatitis, alcohol abuse or unreliable liver stiffness measurement were not excluded. Several cardiovascular characteristics were significantly associated with higher liver stiffness, e.g. heart failure, moderate/poor diastolic dysfunction, and right atrium diameter > 4.5 cm.
Conclusion
In our cohort of community‐dwelling elderly, high liver stiffness was associated with excess mortality, primarily explained by participants with heart failure. Moreover, heart failure and its indicators were associated with increased liver stiffness.</description><subject>Abuse</subject><subject>Aged</subject><subject>Alcohol</subject><subject>Alcoholism</subject><subject>Atria</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Congestive heart failure</subject><subject>Coronary artery disease</subject><subject>Diameters</subject><subject>Drug abuse</subject><subject>Elasticity Imaging Techniques - methods</subject><subject>epidemiology</subject><subject>Failure analysis</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure - epidemiology</subject><subject>Hepatitis</subject><subject>Humans</subject><subject>Liver</subject><subject>Liver Cirrhosis</subject><subject>Liver diseases</subject><subject>liver stiffness</subject><subject>Male</subject><subject>Mortality</subject><subject>Population studies</subject><subject>Prospective Studies</subject><subject>Secondary analysis</subject><subject>Stiffness</subject><subject>survival</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc9LHDEUx0NpUWs99B-QQC_tYTU_NpOMtyKtFRYKrXoNmeSNG8lM1iSjnf71zbrWQ6G5vMD78OG990XoPSUntL7T4B9OqBBcvUIHdCnVgjNOX7_8Gd9Hb3O-I4S2raB7aJ83crlUtD1Av1f-ARLOxff9CDljn7HJOVpvCjj86Msawy-77QwxFRN8mbEfcVkDvoURkgl4EzdTMMXHEbtUdSPuZrwGkwrujQ9TgjN8VfkfsRRIzgz4Z5nc_A696U3IcPRcD9H11y9X598Wq-8Xl-efVwvLlVIL0zonKbWttL2wDaGOMK46oVzHGidaaepShAIXXQ9MtFAv4RoHLetkYw3lh-jjzrtJ8X6CXPTgs4UQzAhxyppJySUjQpGKfvgHvYtTGut0mikipFqyZiv8tKNsijkn6PUm-cGkWVOit4HoGoh-CqSyx8_GqRvAvZB_E6jA6Q549AHm_5v06vJmp_wD5BqWCg</recordid><startdate>202305</startdate><enddate>202305</enddate><creator>Kleef, Laurens A.</creator><creator>Sonneveld, Milan J.</creator><creator>Zhu, Fang</creator><creator>Ikram, M. Arfan</creator><creator>Kavousi, Maryam</creator><creator>Knegt, Robert J.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2333-1182</orcidid></search><sort><creationdate>202305</creationdate><title>Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study</title><author>Kleef, Laurens A. ; Sonneveld, Milan J. ; Zhu, Fang ; Ikram, M. Arfan ; Kavousi, Maryam ; Knegt, Robert J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-a9dd711c97cf5c601d0238b58db26d597a99501e35bfe259e155d6de92b76ca13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abuse</topic><topic>Aged</topic><topic>Alcohol</topic><topic>Alcoholism</topic><topic>Atria</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Congestive heart failure</topic><topic>Coronary artery disease</topic><topic>Diameters</topic><topic>Drug abuse</topic><topic>Elasticity Imaging Techniques - methods</topic><topic>epidemiology</topic><topic>Failure analysis</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Heart Failure - epidemiology</topic><topic>Hepatitis</topic><topic>Humans</topic><topic>Liver</topic><topic>Liver Cirrhosis</topic><topic>Liver diseases</topic><topic>liver stiffness</topic><topic>Male</topic><topic>Mortality</topic><topic>Population studies</topic><topic>Prospective Studies</topic><topic>Secondary analysis</topic><topic>Stiffness</topic><topic>survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kleef, Laurens A.</creatorcontrib><creatorcontrib>Sonneveld, Milan J.</creatorcontrib><creatorcontrib>Zhu, Fang</creatorcontrib><creatorcontrib>Ikram, M. Arfan</creatorcontrib><creatorcontrib>Kavousi, Maryam</creatorcontrib><creatorcontrib>Knegt, Robert J.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kleef, Laurens A.</au><au>Sonneveld, Milan J.</au><au>Zhu, Fang</au><au>Ikram, M. Arfan</au><au>Kavousi, Maryam</au><au>Knegt, Robert J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2023-05</date><risdate>2023</risdate><volume>43</volume><issue>5</issue><spage>1000</spage><epage>1007</epage><pages>1000-1007</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background
Elevated liver stiffness reflects hepatic fibrosis but can also be secondary to venous congestion. We aimed to study the association between liver stiffness and mortality in the general population, stratified for heart failure and/or coronary heart disease (CHD).
Methods
We analysed individuals enrolled in the ongoing prospective population‐based Rotterdam Study who attended a visit between 2009–2014 that included liver stiffness measurement. Exclusion criteria for the primary analysis were incomplete data on heart failure, unreliable liver stiffness, alcohol abuse and viral hepatitis, leaving 4.153 participants (aged 67.5 ± 8.4 years, 44.2% male) for analysis with a median follow‐up of 6.0 (interquartile range: 5.1–7.0) years. Secondary analysis included participants with viral hepatitis, alcohol abuse and/or unreliable measurement. The association between liver stiffness and mortality was assessed using Cox regression. Associations between heart failure, CHD, and echocardiographic characteristics and liver stiffness were quantified with linear regression.
Results
Liver stiffness ≥8.0 kPa was associated with mortality (aHR: 1.37, 95%CI: 1.00–1.89). However, this was driven by participants with heart failure (aHR: 2.48, 95%CI: 1.15–5.35), since high liver stiffness was not associated with mortality in participants without heart failure and/or CHD (aHR: 1.07, 95%CI: 0.70–1.64). Results were consistent when individuals with viral hepatitis, alcohol abuse or unreliable liver stiffness measurement were not excluded. Several cardiovascular characteristics were significantly associated with higher liver stiffness, e.g. heart failure, moderate/poor diastolic dysfunction, and right atrium diameter > 4.5 cm.
Conclusion
In our cohort of community‐dwelling elderly, high liver stiffness was associated with excess mortality, primarily explained by participants with heart failure. Moreover, heart failure and its indicators were associated with increased liver stiffness.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36744819</pmid><doi>10.1111/liv.15538</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2333-1182</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Liver international, 2023-05, Vol.43 (5), p.1000-1007 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Abuse Aged Alcohol Alcoholism Atria Cardiovascular disease Cardiovascular diseases Congestive heart failure Coronary artery disease Diameters Drug abuse Elasticity Imaging Techniques - methods epidemiology Failure analysis Female Fibrosis Heart diseases Heart failure Heart Failure - epidemiology Hepatitis Humans Liver Liver Cirrhosis Liver diseases liver stiffness Male Mortality Population studies Prospective Studies Secondary analysis Stiffness survival |
| title | Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study |
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