Liver fibrosis evaluation in patients with psychiatric diseases

Mental illnesses and psychiatric disorders are public health problems, with an increasing prevalence. Life expectancy of patients is compromised by comorbid somatic illnesses, including liver diseases. Screening for liver fibrosis in this population is challenging.

We assessed liver fibrosis using liver stiffness (LS) measurement by FibroScan® in a large cohort of patients with severe psychiatric disorders receiving psychotropic medications for at least two years. Liver steatosis was evaluated using the Controlled Attenuation Parameter™ (CAP).

355 patients were prospectively included. Advanced fibrosis (LS >8 kPa) prevalence was 6 %. In univariate analysis, advanced fibrosis was associated with high blood pressure (p < 0.001), high ferritin concentration (p = 0.028), and psychotropic drug exposure (p = 0.036). In multivariate analysis, high blood pressure only remained significant (p = 0.002). 34.9 % of patients had significant steatosis (CAP >275 dB/m). In univariate analysis, steatosis was associated with sleep apnea syndrome (p = 0.016), past alcohol dependence (p = 0.013), high body mass index (BMI), type 2 diabetes (p = 0.003), elevated triglycerides (p < 0.001), metabolic syndrome (p < 0.001), metabolic dysfunction-associated liver disease (p < 0.001), and high ferritin concentration (p = 0.008). In multivariable analysis, high BMI and elevated triglycerides remained significant.

Psychiatric patients are at risk of liver fibrosis and steatosis. Systematic screening for liver diseases should be required. Further studies are needed to determine the best strategies for prevention and treatment.