ISRA May 2022

Incidence of Pulmonary Embolism in Hospitalized Patients with Non-Alcoholic Fatty lLver Disease

Ayala Savery 1 Ayala Savery 1 Shadi Shabita 1 Rabea Safadi 1 Yael Kopelman 2 Fadi Abu Baker 2
1Department of Radiology, Hillel Yaffe medical center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel, Israel
2Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel. Affiliated to the Technion Faculty of Medicine, Haifa, Israel, Israel

Background: Recent literature has associated non-alcoholic fatty liver disease (NAFLD) with atherosclerosis; however, very few reports have evaluated the association between NAFLD and venous thromboembolism. The aim of this study was to determine the association between NAFLD and pulmonary embolism (PE) in hospitalized patients.

Methods: In this retrospective case-control study, we included consecutive patients from two university-affiliated hospitals, who were referred for CT pulmonary angiography in the years 2010-2019 for a suspected PE. The imaging studies of the entire cohort were reviewed by two expert radiologists who confirmed the diagnosis of PE and examined the liver to detect hepatic steatosis and to grade it as mild, moderate or severe. Patients with moderate- excessive alcohol consumption and those with chronic liver diseases or cirrhosis were excluded. Accordingly, patients were divided into two groups: those with NAFLD and non-NAFLD controls. Patient demographics, habits, medical history, hospitalization setting and duration as well as patients` outcome were documented and compared between both groups. Multivariate analysis was performed to identify predictors for developing PE, and HRs with corresponding 95% confidence intervals (CI) were estimated.

Results: A total of 377 patients (101 with NAFLD and 276 controls) were included. Subjects with NAFLD had significantly higher values of BMI (33.16±6.78 vs 26.81±5.6; P<0.001) and diabetes (41 (40%) vs. 85 (30.8%); P=0.03). Interestingly, the prevalence of PE was significantly higher in the NAFLD group (80 (79.2%) vs. 147 (53.3%), P<0.001). In multivariate analysis, older age, hospitalization duration longer than 5 days, recent surgery or trauma, active malignancy, smoking and NAFLD (HR ratio=4.339, p

Conclusion: Patients with NAFLD were associated with an increased risk of developing PE independent of other classical risk factors for PE.