Abstract / Summary
Abstract Background Hepatic steatosis is an important cardiometabolic manifestation of psoriatic disease, but routine aminotransferases may fail to identify affected patients. Objective To determine the frequency and clinical-cardiometabolic correlates of ultrasound-detected hepatic steatosis and examine biochemical discordance as a secondary objective. Methods This cross-sectional study included 572 psoriatic adults with or without psoriatic arthritis. Ultrasound data were available in 534 (93.4%). Sequential logistic models evaluated associations with steatosis, prioritizing waist circumference and using body mass index in sensitivity analysis. Secondary analyses examined steatosis with normal aminotransferases and gamma-glutamyl transferase (GGT). Results Hepatic steatosis was detected in 129/534 patients (24.2%). Waist circumference remained associated after cardiometabolic adjustment (odds ratio per 10 cm 1.34, 95% confidence interval 1.10–1.64), whereas psoriatic arthritis and severe skin disease were not. Among 408 patients with normal aspartate and alanine aminotransferases, 37 (9.1%) had steatosis. Elevated GGT identified 28/37 cases, with 75.7% sensitivity, 98.7% specificity, 84.8% positive predictive value and 97.6% negative predictive value. Conclusion Ultrasound-detected hepatic steatosis affected approximately one quarter of evaluable patients and was more closely associated with central adiposity and cardiometabolic factors than with articular or skin disease. Normal aminotransferases did not exclude steatosis; GGT warrants external evaluation as a secondary risk-enrichment marker.