Imperial College London

Dr Benjamin Mullish

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

NIHR Clinical Lecturer
 
 
 
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Contact

 

b.mullish

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Abeles:2019:10.1111/apt.15192,
author = {Abeles, RD and Mullish, BH and Forlano, R and Kimhofer, T and Adler, M and Tzallas, A and Giannakeas, N and Yee, M and Mayet, J and Goldin, RD and Thursz, MR and Manousou, P},
doi = {10.1111/apt.15192},
journal = {Alimentary Pharmacology and Therapeutics},
pages = {1077--1085},
title = {Derivation and validation of a cardiovascular risk score for prediction of major acute cardiovascular events in non-alcoholic fatty liver disease; the importance of an elevated mean platelet volume},
url = {http://dx.doi.org/10.1111/apt.15192},
volume = {49},
year = {2019}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - Background: Atherosclerotic cardiovascular disease is a key cause of morbidity in non-alcoholic fatty liver disease (NAFLD) but appropriate means to predict major acute cardiovascular events (MACE) are lacking. Aims: To design a bespoke cardiovascular risk score in NAFLD. Methods: A retrospective derivation (2008-2016, 356 patients) and a prospective validation (2016- 2017, 111 patients) NAFLD cohort study was performed. Clinical and biochemical data were recorded at enrolment and mean platelet volume (MPV), Qrisk2 and Framingham scores were recorded one year prior to MACE (Cardiovascular death, acute coronary syndrome, stroke, and transient ischaemic attack). Results: The derivation and validation cohorts were well matched with MACE prevalence 12.6% and 12% respectively. On univariate analysis, age, diabetes, advanced fibrosis, collagen proportionate area >5%, MPV and liver stiffness were associated with MACE. After multivariate analysis, age, diabetes and MPV remained independently predictive. The ‘NAFLD CV-risk score’ was generated using binary logistic regression: 85860.06(Age) + 0.963(MPV) + 0.26(DM1) – 16.441 Diabetes mellitus: 1: present; 2: absent. (AUROC 0.84). A cut-off of -3.98 gave a Sensitivity 97%, Specificity 27%, PPV 16%, NPV 99%. An MPV alone of >10.05 gave a sensitivity 97%, specificity 59%, PPV 24% and NPV 97% (AUROC 0.83). Validation cohort AUROCs were comparable at 0.77 (NAFLD CV-risk) and 0.72 (MPV). In the full cohort, the NAFLD CV-risk score and MPV outperformed both Qrisk2 and Framingham scores. Conclusions: The NAFLD CV risk score and MPV accurately predict 1-year risk of MACE thereby allowing better identification of patients that require optimisation of their cardiovascular risk profile.
AU - Abeles,RD
AU - Mullish,BH
AU - Forlano,R
AU - Kimhofer,T
AU - Adler,M
AU - Tzallas,A
AU - Giannakeas,N
AU - Yee,M
AU - Mayet,J
AU - Goldin,RD
AU - Thursz,MR
AU - Manousou,P
DO - 10.1111/apt.15192
EP - 1085
PY - 2019///
SN - 0269-2813
SP - 1077
TI - Derivation and validation of a cardiovascular risk score for prediction of major acute cardiovascular events in non-alcoholic fatty liver disease; the importance of an elevated mean platelet volume
T2 - Alimentary Pharmacology and Therapeutics
UR - http://dx.doi.org/10.1111/apt.15192
UR - http://hdl.handle.net/10044/1/67225
VL - 49
ER -