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Alloveda Liver Update: Fibrosis Stage and Outcomes of Patients with Nonalcoholic Fatty Liver Disease

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eMediNexus    08 June 2020

Biopsy-confirmed liver fibrosis plays a major role in the prognosis of patients with nonalcoholic fatty liver disease (NAFLD). A systematic review was conducted to determine the prognostic value of fibrosis stage in patients with NAFLD and the subgroup of patients with nonalcoholic steatohepatitis (NASH). The review also assessed the evidence for change in fibrosis stage as a surrogate endpoint.

MEDLINE, Embase, Cochrane Library, and trial registry databases were searched up till August 2018 for prospective or retrospective cohort studies pertaining to liver-related clinical events and outcomes in adults with NAFLD or NASH. Data were accumulated on all cause and liver related mortality as well as morbidity (cirrhosis, liver cancer, and all liver-related events) by stage of fibrosis, as assessed by biopsy, for patients with NAFLD or NASH. Fibrosis stage 0 was used as a reference population. Fibrosis stage-specific relative risk (RR) and 95% confidence interval (CI) values were calculated for mortality and morbidities.

Thirteen studies, including 4428 patients with NAFLD were part of this meta-analysis. Overall, 2875 patients had NASH. Compared with no fibrosis (stage 0), unadjusted risk was shown to increase as the stage of fibrosis increased (stage 0 vs. 4):

  • all-cause mortality RR, 3.42 (95% CI, 2.63–4.46);
  • liver-related mortality RR, 11.13 (95% CI, 4.15–29.84);
  • liver transplant RR, 5.42 (95% CI, 1.05–27.89);
  • liver-related events RR, 12.78 (95% CI, 6.85–23.85).

The degree of RR was not significantly different after adjusting for confounders, including age or sex in the subgroup of patients with NASH.

This systematic review and meta-analysis revealed that biopsy-confirmed fibrosis was associated with risk of mortality and liver-related morbidity in patients with NAFLD, be it with or without adjustment for confounding factors, and in patients with NASH.

Source: Taylor RS, Taylor RJ, Bayliss S, et al. Association Between Fibrosis Stage and Outcomes of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Gastroenterology 2020;158:1611–1625.

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