J Rheum Dis.  2023 Oct;30(4):260-267. 10.4078/jrd.2023.0032.

Hepatic steatosis index at diagnosis has the potential for forecasting end-stage kidney disease in patients with antineutrophil cytoplasmic antibody-associated vasculitis

• Choi HJ
• Park PG
• Park YB
• Huh JH
• Lee SW

• KMID: 2546242
• DOI: http://doi.org/10.4078/jrd.2023.0032

Abstract

Objective
This study evaluated whether the hepatic steatosis index (HSI) at antineutrophil cytoplasmic antibody-associated vasculitis (AAV) diagnosis could forecast poor outcomes during the disease course in AAV patients.
Methods
This study included 260 AAV patients. The equation for HSI is as follows: HSI=8×(alanine aminotransferase/aspartate aminotransferase)+body mass index+(2, diabetes mellitus)+(2, female). The cut-off of HSI was obtained using the receiver operating characteristic curve.
Results
The median age of the 260 patients was 59.5 years, and 65.0% were female. Among the continuous variables excluding the parameters composing the equation for HSI, HSI was significantly correlated with Birmingham vasculitis activity score, fivefactor score, haemoglobin, blood urea nitrogen, serum creatinine, and total cholesterol. Among poor outcomes, the area under the curve of HSI for end-stage renal disease (ESRD) was significant, and the cut-off of HSI for ESRD was set at ≤30.82. AAV patients with HSI ≤30.82 exhibited a significantly higher risk of ESRD (relative risk 3.489) and a significantly lower cumulative ESRD-free survival rate than those with HSI >30.82.
Conclusion
This study is the first to demonstrate that HSI at AAV diagnosis could forecast ESRD during the disease course in AAV patients.

Keyword

Hepatic steatosis index; End-stage renal disease; Antineutrophil cytoplasmic antibody; Vasculitis; Forecasting

Figure

• 

  Fig. 1 Receiver operator characteristic curve analysis. Among five poor outcomes of antineutrophil cytoplasmic antibody-associated vasculitis, only hepatic steatosis index (HIS) for ESRD showed statistical significance (area under the curve 0.333 for the presence of ESRD, p<0.001 and 0.670 for the absence of ESRD, p<0.001). The optimal cut-off of HSI for ESRD was set at ≤30.82. CI: confidence interval, CVA: cerebrovascular accident, ACS: acute coronary syndrome, ESRD: end-stage renal disease.

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  Fig. 2 Relative risk for ESRD. Antineutrophil cytoplasmic antibody-associated vasculitis patients with HSI ≤30.82 exhibited a significantly higher risk of progression to ESRD than those with HSI >30.82. ESRD: end-stage renal disease, HSI: hepatic steatosis index.

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  Fig. 3 Cumulative ESRD-free survival rates. Antineutrophil cytoplasmic antibody-associated vasculitis patients with HSI ≤30.82 exhibited a significantly lower cumulative ESRD-free survival rate than those with HSI >30.82 (p=0.001). ESRD: end-stage renal disease, HSI: hepatic steatosis index.

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