Histopathologic correlation of nonalcoholic fatty liver with coronary artery atherosclerosis in forensic case of East Azerbaijan province

Abstract

Atherosclerosis is a vascular disease characterized by low-density lipid and cholesterol deposition on the inner wall of medium and large diameter arteries. This process results in the formation of fibrous-fat plaques (atheroma) that increase with age and cause stenosis or other complications. This study aimed to determine the relationship between non-alcoholic fatty liver disease severity and the degree of coronary atherosclerosis. Materials and Methods: In this study, patients who died in 2015, 2016 and 2017 and underwent simultaneous liver and coronary artery biopsy due to referral to forensic medicine were studied in a case series that collected data from 205 patients. Finally, 35 patients were excluded from the study due to exclusion criteria (history of alcohol consumption, viral hepatitis, autoimmune hepatitis, etc.), and finally, 170 patients were examined. First, pathological slides of these patients were extracted from the forensic medical archive and re-examined based on the grading and staging mentioned in this study. In the next step, the selected patients' blocks were extracted from the tissue block bank, and again, after preparing a new slide, they were stained with trichrome for accurate estimation of liver fibrosis. Results: The mean age of the patients was 49.21 years, and 77.6% were male. The most common reason for referring to forensic medicine (cause of death) was a sudden death and underlying disease. Assessment of NAFLD histological status in the studied patients showed that in general, 74.7% of patients are Grade I, 19.4% are Grade II and 5.9% are Grade III. Most patients with coronary atherosclerosis were classified as Herbert Stay, Type I (20.6%) and Normal (19.4%). There was no statistically significant relationship between the severity of simple steatosis and coronary atherosclerosis (p = 0.550). More than half of the patients (57%) had liver cell involvement between 5% and 66%, although these patients were classified as Type III to Type V in terms of Herbert Stay classification. The mean score of steatohepatitis in the studied patients was 2.39, which was not significantly correlated with the severity of coronary atherosclerosis (p = 0.447). No statistically significant relationship was observed between the final Grade of NAFLD and the severity of coronary atherosclerosis. In patients with higher severity of coronary atherosclerosis, liver fibrosis rate is also higher, but no statistically significant difference was observed (p = 0.320).