A0471 - Hepatic Steatosis and Fibrosis in Patients With Gout Detected by Elastography

Ankoor H. Patel, MD¹, Vinod Rustgi, MD, MBA¹, Anthony E. Yeo, MBBS, PhD, MPH², Peter Lipsky, MD³, Naomi Schlesinger, MD^1
1Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ; ²Yeo Analytics LLC, Jersey City, NJ; ³AMPEL BioSolutions, Charlottesville, VA

Introduction: Gout is associated with non-alcoholic fatty liver disease (NAFLD), but neither the frequency nor severity of NAFLD in gout is well described. Elastography is a well-established ultrasonic method to evaluate both steatosis and fibrosis in the liver but has not been applied to evaluate gout patients.

Methods: We employed the FibroScan to evaluate patients with advanced gout at one center from 11/1/2016-11/12021. We assessed the Fibrosis score (kPA), which measures liver stiffness (E score), and the controlled attenuation parameter dB/m (CAP) score, which measures steatosis. In addition, we assessed the four-factor fibrosis (FIB-4) Index formula.

Results: 47 gout patients (7 females, 14.9%; 40 males, 85.1%) were evaluated. The mean age was 59.8 years and the mean BMI was 30.95 kg/m2. Tophi were present in 11. Disease duration ranged from 0-49 years. Comorbidities included: dyslipidemia (86.7%), DM (31.1%), HTN (63.6%), CHF (12.8%), CAD (12.8%), CKD (19.15%), known liver disease (33.3%) and current alcohol use (46.8%). 53.7% had hyperuricemia and 54.4% had elevations in ALT/AST.

Hepatic steatosis was found in 40 (85.1%), but was not significantly different in males or females (p=0.37) or those with CHF (p=0.87), CAD (p=0.94), HTN (p=0.17), DM (p=0.68), dyslipidemia (p=0.59) or the presence of known liver diseases (p=0.37). CAP was correlated with BMI (r=0.53, p=0.0001) but not age, serum urate (SU), glucose, triglycerides (TGs), ALT, AST, FIB-4, or Fibrosis scores. By Fibroscan, 9 (19.1%) had evidence of fibrosis (E score >7), including one with moderate and 8 with severe fibrosis (cirrhosis). Moderate or severe fibrosis was significantly associated with age (p=0.03), known liver disease (p=0.003), but not ancestry, gender, BMI, TGs, HDL, glucose, gout duration, CHF, CAD, HTN, dyslipidemia, or DM. SU was comparable in those with or without moderate or severe fibrosis (p=0.24). The Fib-4 score was significantly greater in those with severe or moderate fibrosis (3.77) versus those with no or mild fibrosis (1.59, p=0.0045). There was a significant correlation between the Fibrosis score and FIB-4 score (r2=0.24, p=0.0009), but not between the Fibrosis score and ALT (p=0.44) or AST(p=0.41).

Discussion: Hepatic steatosis and fibrosis are common in patients with gout, but not associated with typical gout co-morbidities. Screening for NAFLD with elastography should establish the actual frequency of NAFLD in gout and provide a means to manage this co-morbidity more effectively.


Disclosures:


Ankoor H. Patel, MD¹, Vinod Rustgi, MD, MBA¹, Anthony E. Yeo, MBBS, PhD, MPH², Peter Lipsky, MD³, Naomi Schlesinger, MD¹. A0471 - Hepatic Steatosis and Fibrosis in Patients With Gout Detected by Elastography, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.