Independent Associations of Aortic Calcification with Cirrhosis and Liver Related Mortality in Veterans with Chronic Liver Disease

Steven R Horbal; Patrick X Belancourt; Peng Zhang; Sven A Holcombe; Sameer Saini; Stewart C Wang; Anne E Sales; Grace L Su

doi:10.1007/s10620-024-08450-5

Independent Associations of Aortic Calcification with Cirrhosis and Liver Related Mortality in Veterans with Chronic Liver Disease

Dig Dis Sci. 2024 Apr 23. doi: 10.1007/s10620-024-08450-5. Online ahead of print.

Authors

Steven R Horbal^{1

2}, Patrick X Belancourt³, Peng Zhang^{4

5}, Sven A Holcombe^{4

5}, Sameer Saini⁶, Stewart C Wang⁴, Anne E Sales^{3

7}, Grace L Su^{6

8}

Affiliations

¹ Department of Surgery, University of Michigan, Ann Arbor, MI, USA. shorbal@med.umich.edu.
² Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA. shorbal@med.umich.edu.
³ VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁴ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
⁵ Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA.
⁶ Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
⁷ Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Colombia, MO, USA.
⁸ Gastroenterology Section, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA.

PMID: 38653948
DOI: 10.1007/s10620-024-08450-5

Abstract

Introduction: Abdominal aortic calcifications (AAC) are incidentally found on medical imaging and useful cardiovascular burden approximations. The Morphomic Aortic Calcification Score (MAC) leverages automated deep learning methods to quantify and score AACs. While associations of AAC and non-alcoholic fatty liver disease (NAFLD) have been described, relationships of AAC with other liver diseases and clinical outcome are sparse. This study's purpose was to evaluate AAC and liver-related death in a cohort of Veterans with chronic liver disease (CLD).

Methods: We utilized the VISN 10 CLD cohort, a regional cohort of Veterans with the three forms of CLD: NAFLD, hepatitis C (HCV), alcohol-associated (ETOH), seen between 2008 and 2014, with abdominal CT scans (n = 3604). Associations between MAC and cirrhosis development, liver decompensation, liver-related death, and overall death were evaluated with Cox proportional hazard models.

Results: The full cohort demonstrated strong associations of MAC and cirrhosis after adjustment: HR 2.13 (95% CI 1.63, 2.78), decompensation HR 2.19 (95% CI 1.60, 3.02), liver-related death HR 2.13 (95% CI 1.46, 3.11), and overall death HR 1.47 (95% CI 1.27, 1.71). These associations seemed to be driven by the non-NAFLD groups for decompensation and liver-related death [HR 2.80 (95% CI 1.52, 5.17; HR 2.34 (95% CI 1.14, 4.83), respectively].

Discussion: MAC was strongly and independently associated with cirrhosis, liver decompensation, liver-related death, and overall death. Surprisingly, stratification results demonstrated comparable or stronger associations among those with non-NAFLD etiology. These findings suggest abdominal aortic calcification may predict liver disease severity and clinical outcomes in patients with CLD.

Keywords: Abdominal aortic calcification; Alcohol-associated liver disease; Body composition biomarkers; Hepatitis C; Non-alcoholic fatty liver disease.