title: Non alcoholic fatty liver disease increases the mortality from acute coronary syndrome: an observational study from Sri Lanka.
abstract: BACKGROUND
  Non alcoholic fatty liver disease is an independent risk factor for coronary artery disease. But its effect on acute coronary syndrome is not clear. We performed this study to identify the prevalence of NAFLD in patients with ACS admitted to a tertiary care center in Sri Lanka. We also described the association of NAFLD with the severity of ACS predicted by the GRACE score.
  
  
  METHODS
  We performed a descriptive study including all consecutive patients with non-fatal ACS admitted to Colombo South Teaching Hospital from 01/02/2014 to 30/04/2014. Patients with excessive alcohol consumption, established cirrhosis and patients with identified risk factors for liver disease were excluded from the study. All patients underwent ultrasound scan of liver.
  
  
  RESULTS
  There were 120 participants, 75 (62.5%) males and 45 (37.5%) females with acute coronary syndrome. Average age was 61.28 ± 11.83 years. NAFLD was seen in 56 (46.7%) patients with ACS. Patients with NAFLD had a higher GRACE score than patients without NAFLD (120.2 ± 26.9 Vs 92.3 ± 24.2, p < 0.001). Increased age and presence of NAFLD conferred a higher mortality risk from ACS as predicted by GRACE score. Patients with NAFLD had a higher predicted mortality during in-ward stay (adjusted OR 31.3, CI 2.2-439.8, p = 0.011) and at 6 months after discharge (adjusted OR 15.59, CI 1.6-130.6, p = 0.011).
  
  
  CONCLUSIONS
  Patients with NAFLD have a higher predicted mortality from acute coronary syndrome and thus require aggressive treatment of CAD. It is important to consider this novel risk factor when risk stratifying patients with ACS.
authors: Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. nilanka.dushani@gmail.com.
authors: Nilanka
authors: N
authors: Perera
authors: Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. indrak2004@gmail.com.
authors: Jegarajah
authors: J
authors: Indrakumar
authors: Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. waruniabeysinghe@gmail.com.
authors: Waruni Vijitha
authors: WV
authors: Abeysinghe
authors: Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. vingifernando@gmail.com.
authors: Vihangi
authors: V
authors: Fernando
authors: Department of Radiology, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. mudithcks@gmail.com.
authors: W M C K
authors: WM
authors: Samaraweera
authors: Department of Radiology, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. swinflower@gmail.com.
authors: Jayamal Sanjaya
authors: JS
authors: Lawrence
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013188:Sri Lanka / Q000453:epidemiology; D062606:Tertiary Care Centers