Metabolic syndrome and female gender, but not methotrexate, are the important associations of significant liver fibrosis in patients with moderate-to-severe psoriasis as detected by transient elastography
Rahul Mahajan1, Sunil Dogra1, Sanjeev Handa1, T Muhammed Razmi1, Tarun Narang1, Sahaj Rathi2, Radha Krishan Dhiman2, Biman Saikia3, Adil Karim3
1 Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
2 Department of Hepatology, PGIMER, Chandigarh, India
3 Department of Immunopathology, PGIMER, Chandigarh, India
Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Background: Many international guidelines on psoriasis management have emphasized upon the need to identify risk factors for liver fibrosis and that the risk may be increased after a certain total cumulative dose of methotrexate.
Methods: Consecutive patients with moderate-to-severe psoriasis were assessed for liver fibrosis using transient elastography and noninvasive scores. Based on the presence of significant liver fibrosis, the Odds ratio associated with various factors was calculated using logistic regression analysis. Receiver operating characteristic curves were calculated to find maximal cutoff values of noninvasive tests to detect fibrosis.
Results: In this cross-sectional study, 134 patients completed the study. Significant fibrosis (liver stiffness measurement ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Female sex (P = 0.024) and the presence of metabolic syndrome (P = 0.034) were the two variables associated with significant liver fibrosis. On logistic regression analysis, the odds ratio for the female gender and metabolic syndrome was estimated to be 2.51 (95% confidence interval - 1.09–5.81) and 2.33 (95% confidence interval - 1.03–5.27), respectively. Aspartate transaminase to platelet ratio index, nonalcoholic fatty liver disease score and the fibrosis-4 index had low sensitivity in comparison to transient elastography.
Limitations: These included small sample size, small number of patients with a total cumulative methotrexate dose of >3–4.5 g, and lack of control group consisting of healthy persons. Another is the absence of liver biopsies considered as the gold standard in the diagnosis of liver fibrosis.
Conclusions: Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. Methotrexate exposure does not seem to be significantly associated with significant liver fibrosis.