RESEARCH ARTICLE
Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease Serena Pelusi1, Salvatore Petta2, Chiara Rosso3, Vittorio Borroni1, Anna Ludovica Fracanzani1, Paola Dongiovanni1, Antonio Craxi2, Elisabetta Bugianesi3, Silvia Fargion1, Luca Valenti1*
a11111
1 Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy, 2 Gastroenterology, Università di Palermo, Palermo, Italy, 3 Gastroenterology, Dept. of Medical Sciences, Università di Torino, Torino, Italy * [email protected]
Abstract OPEN ACCESS Citation: Pelusi S, Petta S, Rosso C, Borroni V, Fracanzani AL, Dongiovanni P, et al. (2016) ReninAngiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease. PLoS ONE 11(9): e0163069. doi:10.1371/ journal.pone.0163069
Background
Editor: Vincent Wong, The Chinese University of Hong Kong, HONG KONG
To assess the clinical determinants of fibrosis progression rate (FPR) in NAFLD patients with baseline and follow-up histological evaluation, with a special focus on the impact of pharmacological therapy.
Received: August 6, 2016
The clinical determinants of fibrosis progression in nonalcoholic fatty liver disease (NAFLD) are still under definition.
Aim
Accepted: September 1, 2016 Published: September 20, 2016 Copyright: © 2016 Pelusi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: LV was funded by MyFirst AIRC (Italian Association for Cancer Research) grant n.16888 and Ricerca corrente Fondazione IRCCS Ca´ Granda Milano, Molecular Medicine Grant Fondazione-INGM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Methods In an observational cohort of 118 Italian patients from tertiary referral centers, liver histology was evaluated according to Kleiner. Independent predictors of FPR were selected by a stepwise regression approach.
Results Median follow-up was 36 months (IQR 24–77). Twenty-five patients (18%) showed some amelioration, 63 (53%) had stability, 30 (25%) had progression of fibrosis. Patients with nonalcoholic steatohepatitis (NASH) had similar demographic and anthropometric features, but a higher prevalence of type 2 diabetes (T2D; p = 0.010), and use of renin-angiotensin axis system (RAS) inhibitors (p = 0.005). Fibrosis progression was dependent of the length of follow-up, and was associated with, but did not require, the presence of NASH (p
Renin-Angiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease Serena Pelusi1, Salvatore Petta2, Chiara Rosso3, Vittorio Borroni1, Anna Ludovica Fracanzani1, Paola Dongiovanni1, Antonio Craxi2, Elisabetta Bugianesi3, Silvia Fargion1, Luca Valenti1*
a11111
1 Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy, 2 Gastroenterology, Università di Palermo, Palermo, Italy, 3 Gastroenterology, Dept. of Medical Sciences, Università di Torino, Torino, Italy * [email protected]
Abstract OPEN ACCESS Citation: Pelusi S, Petta S, Rosso C, Borroni V, Fracanzani AL, Dongiovanni P, et al. (2016) ReninAngiotensin System Inhibitors, Type 2 Diabetes and Fibrosis Progression: An Observational Study in Patients with Nonalcoholic Fatty Liver Disease. PLoS ONE 11(9): e0163069. doi:10.1371/ journal.pone.0163069
Background
Editor: Vincent Wong, The Chinese University of Hong Kong, HONG KONG
To assess the clinical determinants of fibrosis progression rate (FPR) in NAFLD patients with baseline and follow-up histological evaluation, with a special focus on the impact of pharmacological therapy.
Received: August 6, 2016
The clinical determinants of fibrosis progression in nonalcoholic fatty liver disease (NAFLD) are still under definition.
Aim
Accepted: September 1, 2016 Published: September 20, 2016 Copyright: © 2016 Pelusi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: LV was funded by MyFirst AIRC (Italian Association for Cancer Research) grant n.16888 and Ricerca corrente Fondazione IRCCS Ca´ Granda Milano, Molecular Medicine Grant Fondazione-INGM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Methods In an observational cohort of 118 Italian patients from tertiary referral centers, liver histology was evaluated according to Kleiner. Independent predictors of FPR were selected by a stepwise regression approach.
Results Median follow-up was 36 months (IQR 24–77). Twenty-five patients (18%) showed some amelioration, 63 (53%) had stability, 30 (25%) had progression of fibrosis. Patients with nonalcoholic steatohepatitis (NASH) had similar demographic and anthropometric features, but a higher prevalence of type 2 diabetes (T2D; p = 0.010), and use of renin-angiotensin axis system (RAS) inhibitors (p = 0.005). Fibrosis progression was dependent of the length of follow-up, and was associated with, but did not require, the presence of NASH (p
