Identification of risk factors associated with metabolic dysfunction-associated steatotic liver disease in psoriatic patients

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common cause of chronic liver disease. Patients suffering from psoriasis are at an increased risk of developing MASLD. Psoriasis and MASLD share a pro-inflammatory cytokine milieu, however it is still unclear whether these conditions are related through shared metainflammatory processes or shared comorbidities such as obesity, diabetes, insulin resistance and metabolic syndrome. The aim of our study was to better characterise the anthropometric and metabolic profile of psoriatic patients with MASLD. Methods. We conducted a prospective, single centre, cross-sectional study between June 2014 and August 2017. Recruitment was restricted to adult patients with psoriasis. Blood analysis, liver ultrasonography and a fibroscan were performed. Blood investigations, baseline anthropometric measurements and components of fatty liver disease (hepatic ultrasound, fibroscan) were assessed. Results. 100 patients were recruited. Of which, 43% (65.1% men, n=28) were diagnosed with MASLD. The mean body mass index (BMI) was significantly higher in MASLD than in non-MASLD (27.7kg/m2 vs 30.1kg/m2, p=<0.001). The mean waist circumference in MASLD patients was significantly higher than in non-MASLD patients (105.6cm vs 97.2cm, p=0.005). There was no significant difference between the mean age of both patient groups (50.4 vs 47.3 years, p=0.26). Psoriatic arthritis was more prevalent in MASLD than in the non-MASLD group (14.3% vs 1.8%, p=0.004). Biochemical analysis revealed significantly higher C-peptide level in patients with MASLD compared with patients without MASLD (2.5 vs 1.6ng/ml, p=0.036). Moreover, MASLD patients were found to have a lower HDL level and higher glycemia, triglyceridemia, cholesterol and LDL levels than non-MASLD patients. 16.3% of patients with MASLD had fibrosis stage ranging from F2 to F4 based on liver stiffness measurement compared with only 10.6% of patients without MASLD. Discussion. We identified parameters which were more prevalent in patients with psoriasis having MASLD, specifically a high BMI, elevated triglycerides levels, decreased HDL levels and an elevate level of C-peptide. Patients with psoriasis and MASLD were more likely to suffer from co-morbid psoriatic arthritis, despite having similar psoriasis disease severity as measured by PASI. Conclusion. This study highlights the importance of screening patients with psoriasis for MASLD to prevent the progression to liver fibrosis.