Clusters of risk factors for the development of comorbidity in patients with somatic pathology

The significant prevalence and severe medical and social consequences of comorbidity dictate the need to determine the etiopathogenetic risk factors that contribute to its formation. Purpose of the study: to study the associations of metabolic factors (arterial hypertension, obesity, hyperglycemia, dyslipidemia, hyperuricemia, increased serum concentration of C-reactive protein (CRP) with a high degree of comorbidity in patients with somatic pathology. Material and methods. An analytical retrospective study was carried out including data from the medical records of 5296 patients at a therapeutic clinic, men and women, aged from 18 to 92 years (56.4 ± 0.2 years). Comorbidity was taken into account in the presence of two or more nosologies in one patient, its degree was assessed by the number of nosologies in one patient. The following risk factors were assessed: arterial hypertension, obesity, hyperglycemia, dyslipidemia, hyperuricemia, increased concentration of CRP. The presence of non-alcoholic fatty liver disease (NAFLD) was also taken into account. The association of the considered factors with a high degree of comorbidity was assessed using logistic regression analysis. Results and discussion. The relations have been established between NAFLD, age over 52 years, female gender, as well as the considered metabolic factors with a high degree of comorbidity. NAFLD, age, obesity and hyperglycemia had the strongest associations with comorbidity. NAFLD increased the risk of developing a high degree of comorbidity by 5.6 times (odds ratio (OR) 5.59, 95 % confidence interval (CI) 4.40–7.11), age over 52 years – by 2.6 times (OR 2.60, 95 % CI 2.30–2.95); obesity – by 2.4 times (OR 2.37, 95 % CI 2.08–2.70), hyperglycemia – by 2.1 times (OR 2.05, 95 % CI 1.69–2. 49). Conclusions. The data obtained indicate the importance of NAFLD, as well as metabolic risk factors for CND, in increasing the likelihood of developing a high degree of comorbidity, which must be taken into account when developing programs for the prevention and treatment.

1. Oganov R.G., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Barbarash O.L., Boytsov S.A., Boldueva S.A., Garganeeva N.P., Doshchitsin V.L., Karateev A.E., … Shal’nova S.A. Comorbidities in clinical practice. Algorithms for diagnosis and treatment. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2019;18(1):5–66. [In Russian]. doi: 10.15829/1728-8800-2019-1-5-66

2. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222. doi: 10.1016/S0140-6736(20)30925-9

3. Skou S.T., Mair F.S., Fortin M., Guthrie B., Nunes B.P., Miranda J.J., Boyd C.M., Pati S., Mtenga S., Smith S.M. Multimorbidity. Nat. Rev. Dis. Primers. 2022;8(1):48. doi: 10.1038/s41572-022-00376-4

4. Willadsen T.G., Siersma V., Nicolaisdóttir D.R., Køster-Rasmussen R., Jarbøl D.E., Reventlow S., Mercer S.W., Olivarius N.F. Multimorbidity and mortality: A 15-year longitudinal registry-based nationwide Danish population study. J. Comorb. 2018;8(1):2235042X18804063. doi: 10.1177/2235042X18804063

5. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., Barbarash O.L., Boitsov S.A., Vavilova T.V., Villevalde S.V., … Yanishevsky S.N. Arterial hypertension in adults. Clinical guidelines 2020. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020;25(3):149–218. [In Russian]. doi: 10.15829/1560-4071-2020-3-3786

6. Ivashkin V.T., Maevskaya M.V., Pavlov Ch.S., Tikhonov I.N., Shirokova E.N., Bueverov A.O., Drapkina O.M., Shul’pekova Ju.O., Tsukanov V.V., Mammaev S.N., Maev I.V., Pal’gova L.K. Diagnostics and treatment of non-alcoholic fatty liver disease: clinical guidelines of the russian scientific liver society and the russian gastroenterological association. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(2):24–42. [In Russian]. doi: 10.22416/1382-4376-2016-26-2-24-42

7. Kivimäki M., Kuosma E., Ferrie J.E., Luukkonen R., Nyberg S.T., Alfredsson L., Batty G.D., Brunner E.J., Fransson E., Goldberg M., … Jokela M. Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health. 2017;2(6):e277– e285. doi: 10.1016/S2468-2667(17)30074-9

8. Livzan M.A., Gaus O.V., Nikolaev N.A., Krolevets T.S. NAFLD: comorbidity and associated diseases. Eksperimental’naya i klinicheskaya gastroenterologiya = Experimental and Clinical Gastroenterology. 2019;170(10):57–65. [In Russian]. doi: 10.31146/1682-8658-ecg-170-10-57-65

9. Bilson J., Sethi J.K., Byrne C.D. Non-alcoholic fatty liver disease: a multi-system disease influenced by ageing and sex, and affected by adipose tissue and intestinal function. Proc. Nutr. Soc. 2022;81(2):146–161. doi: 10.1017/S0029665121003815

10. Ponti F., Santoro A., Mercatelli D., Gasperini C., Conte M., Martucci M., Sangiorgi L., Franceschi C., Bazzocchi A. Aging and imaging assessment of body composition: from fat to facts. Front. Endocrinol. (Lausanne). 2020;10:861. doi: 10.3389/fendo.2019.00861

11. Narasimhan A., Flores R.R., Robbins P.D., Niedernhofer L.J. Role of cellular senescence in type ii diabetes. Endocrinology. 2021;162(10):bqab136. doi: 10.1210/endocr/bqab136

12. Wetterling T. Pathogenesis of multimorbidity-whatisknown? Z. Gerontol. Geriatr. 2021;54(6):590–596. doi: 10.1007/s00391-020-01752-z

13. Zhang Z., Zhao L., Zhou X., Meng X., Zhou X. Role of inflammation, immunity, and oxidative stress in hypertension: New insights and potential therapeutic targets. Front. Immunol. 2023;13:1098725. doi: 10.3389/fimmu.2022.1098725

14. Rizzoni D., de Ciuceis C., Szczepaniak P., Paradis P., Schiffrin E.L., Guzik T.J. Immune system and microvascular remodeling in humans. Hypertension. 2022;79(4):691–705. doi: 10.1161/HYPERTENSIONAHA.121.17955

15. Kimura Y., Yanagida T., Onda A., Tsukui D., Hosoyamada M., Kono H. Soluble uric acid promotes atherosclerosis via ampk (amp-activated protein kinase)-mediated inflammation. Arterioscler. Thromb. Vasc. Biol. 2020;40(3):570–582. doi: 10.1161/ATVBAHA.119.313224

16. Raposeiras-Roubin S., Rosselló X., Oliva B., Fernández-Friera L., Mendiguren J.M., Andrés V., Bueno H., Sanz J., Martínez de Vega V., Abu-Assi E., … Fuster V. Triglycerides and residual atherosclerotic risk. J. Am. Coll. Cardiol. 2021;77(24):3031–3041. doi: 10.1016/j.jacc.2021.04.059

17. Sproston N.R., Ashworth J.J. Role of C-reactive protein at sites of inflammation and infection. Front. Immunol. 2018;9:754. doi: 10.3389/fimmu.2018.00754

18. Sergienko I.V., Ansheles A.A., Kukharchuk V.V. Dyslipidemia, atherosclerosis and coronary heart disease, genetics, pathogenesis, phenotypes, diagnosis, therapy, comorbidity. Moscow: PatiSS, 2020. 298 p. [In Russian].