Nonalcoholic fatty liver disease and atrial fibrillation: the main markers of this association

Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) has increased globally in recent years. According to recent studies, NAFLD and AF affect approximately 32 % and 0.51 % of the general population, respectively. Aim. To examine the association between NAFLD and AF by using the FibroTest-4 (FIB-4) and the NAFLD Fibrosis score (NFS) and measuring periostin levels. Materials and methods. In this study, we enrolled 96 patients diagnosed with NAFLD and divided them in two groups, the main group – 35 patients with NAFLD + AF and the control group – 61 patients with NAFLD alone. NFS and FIB-4 indices were calculated and serum periostin level was measured. Results. The NAFLD + AF group had higher levels of periostin (10.80 ± 1.60 ng/ml vs. 9.80 ± 1.75 ng/ml, p < 0.001) and higher NFS (-1.05 ± 1.46 vs. -2.65 ± 1.63, p < 0.001) and FIB-4 scores (1.34 ± 0.86 vs 1.07 ± 0.60, p = 0.048). Periostin has been found to be associated with the risk of NAFLD + AF with an OR of 2.079 (95 % CI: 1.418–3.048, p < 0.001). Similar results were with NFS (OR = 3.233, 95 % CI: 1.970–5.303, p < 0.001) and FIB-4 (OR = 2.498, 95 % CI: 1.109–5.627, p = 0.027). The receiver operating characteristic (ROC) analysis was performed using three variables, NFS, FIB-4 and periostin, to determine their ability to distinguish between patients with NAFLD + AF and NAFLD alone. The results have shown that the NFS had the highest area under the curve (AUC) with a value of 0.868 (95 % CI: 0.792–0.943, p < 0.001), indicating excellent discriminatory ability. FIB-4 had an AUC of 0.651 (95 % CI: 0.537–0.765, p = 0.014), while periostin had an AUC of 0.759 (95 % CI: 0.660–0.858, p < 0.001). Conclusions. These findings have suggested a strong association between NAFLD and AF and highlighted the importance of considering AF as a potential complication in patients with NAFLD. Both the use of the FIB-4 and NFS indices and measurement of periostin levels have been proved to be effective in detecting this association.