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SERUM IRON MARKERS IN RELATION TO HEPATOCELLULAR CARCINOMA RISK AMONG PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Yu, Yichuan (2021) SERUM IRON MARKERS IN RELATION TO HEPATOCELLULAR CARCINOMA RISK AMONG PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Background: In recent years, non-alcoholic fatty liver disease (NAFLD) has been recognized as a new risk factor for HCC. Iron is an essential element for humans and hepatocytes are its main storage location. High absorption of iron from intestine due to iron-rich dietary pattern or hemochromatosis may result in hepatic iron overload. Epidemiologic data on the associations between different serum iron markers and risk of HCC are rare. In this study, we examined the association between four iron measurements in pre-diagnosed serum with the risk of HCC development in NAFLD patients. Methods: We identified 47,970 NAFLD patients in the electronic health records (EHRs) of the University of Pittsburgh Medical Center (UPMC) Healthcare System from 1/1/2004 through 12/31/2018. 19,925 of the population had at least one measurement of serum iron, transferrin saturation, total iron binding capacity and serum ferritin. A total of 192 NAFLD patients were diagnosed with HCC at least 30 days after measurement of serum iron markers with an average 4.15 years of follow-up. Cox proportional hazard regression model adjusted for age, sex, race, body mass index, history of diabetes and tobacco smoking were used to calculate hazard ratios (HRs) and the 95% confidence intervals (CIs) for HCC incidence associated with elevated levels of the four iron markers were obtained. Results: Serum iron and transferrin saturation were significantly elevated in NAFLD patients who developed HCC than NAFLD patients who remained free of HCC during the study period. HR of HCC for elevated serum iron >175 mcg/dl was 2.44 (95% CI 1.06 – 5.58) compared to its normal range at 75–175 mcg/dl. Similarly, HR for HCC associated with high transferrin saturation level (>35%) was 2.18 (95% CI 1.27 – 3.74) compare to its normal range at 25-35%. We did not find statistically significant associations for TIBC and serum ferritin with the risk of HCC. Conclusions: Elevated serum iron and transferrin saturation levels are significantly associated with increased risk of developing HCC in NAFLD patients. These findings could offer an important part in public health as serum iron level could be monitored clinically among NAFLD patients as early HCC prevention and detection.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Yu, Yichuanyiy72@pitt.eduyiy72
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairYuan, Jian-Minyuanj@upmc.eduyuanj
Committee MemberBehari, Jaideepbehajx@UPMC.EDUjab31
Committee MemberYouk, Ada O.ayouk@pitt.eduayouk
Committee MemberGlynn, Nancy W.EPIDNWG@pitt.eduEPIDNWG
Date: 12 May 2021
Date Type: Publication
Defense Date: 7 April 2021
Approval Date: 12 May 2021
Submission Date: 20 April 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 51
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: hepatocellular carcinoma, iron overload, non-alcoholic fatty liver disease, electronic health records
Date Deposited: 12 May 2021 18:24
Last Modified: 12 May 2021 18:24
URI: http://d-scholarship.pitt.edu/id/eprint/40870

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  • SERUM IRON MARKERS IN RELATION TO HEPATOCELLULAR CARCINOMA RISK AMONG PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE. (deposited 12 May 2021 18:24) [Currently Displayed]

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