한빛사 논문
Peter Konyn MD1, Omar Alshuwaykh MD2, Brittany B. Dennis MD, PhD3, George Cholankeril MD, MSECR4,5, Aijaz Ahmed MD2, Donghee Kim MD, PhD2,*
1Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
2Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
3Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
4Liver Center, Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas
5Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
*Corresponding author.
Abstract
Background and Aims
Presence of gallstone disease may influence outcomes in patients with nonalcoholic fatty liver disease (NAFLD). We studied the impact of gallstone disease on mortality in individuals with and without NAFLD.
Methods
Prospective cohort study using the Third National Health and Nutrition Examination Survey (1988-1994) with mortality data through 2015. Gallstone disease was defined as ultrasonographic evidence of gallstones or absence of the gallbladder (prior cholecystectomy). NAFLD was defined using standardized ultrasonographic criteria.
Results
Gallstone disease and cholecystectomy were independently associated with NAFLD (odds ratio [OR]: 1.75, 95% confidence interval [CI]: 1.43-2.15 for gallstone disease and OR: 2.77, 95% CI: 2.01-3.83 for cholecystectomy compared to no gallstone disease). During the median follow-up of 23 years, gallstone disease was associated with a higher risk of overall all-cause mortality (hazard ratio [HR]: 1.19, 95% CI: 1.05-1.37) and cause-specific mortality. Gallstone disease was associated with a higher risk of all-cause mortality in non-NAFLD sub-cohort (HR: 1.42, 95% CI 1.23-1.64), but not in NAFLD (HR: 1.03, 95% CI: 0.87-1.22). Gallstone disease was associated with a higher risk of cardiovascular (HR: 1.40, 95% CI 1.10-1.78) and cancer (HR: 1.71, 95% CI: 1.18-2.48)-related mortality in non-NAFLD sub-cohort. Gallstone disease was associated with increased cardiovascular mortality (HR: 1.36, 95% CI: 1.05-1.77) in NAFLD.
Conclusion
Gallstone disease is an independent risk factor for NAFLD, but gallstone disease is not associated with all-cause mortality in individuals with NAFLD. Screening for gallstone disease in individuals at risk for developing NAFLD may help with risk stratification for all-cause mortality related to gallstone disease.
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