Liver Fibrosis Measurement Linked to High Mortality Risk in NAFLD Cases

A systematic review published in Liver International investigated liver stiffness measurement (LSM) in patients with nonalcoholic fatty liver disease (NAFLD) have revealed a significant association between liver fibrosis and an elevated risk of all-cause mortality. 

Stefano Ciardullo and team conducted a comprehensive review of observational cohort studies published up to April 2023. The studies included in the analysis involved patients with NAFLD or individuals from the general population who had undergone LSM using vibration-controlled transient elastography (VCTE). To be included in the meta-analysis, studies needed to have a follow-up period of at least one year and provide data on all-cause mortality. After meticulous screening, seven studies encompassing 18,771 participants were selected. The data used were derived from models with the highest degree of adjustment for potential confounding factors available in each study.

The meta-analysis yielded compelling results. When LSM was analyzed as a categorical variable based on specific cut-off points for liver fibrosis, it was associated with a substantially increased risk of all-cause mortality (Hazard Ratio [HR] 2.10, 95% Confidence Interval [CI] 1.56–2.83; p < 0.001). Similarly, when LSM was treated as a continuous variable, every 1-kilopascal (kPa) increase in liver stiffness was linked to a 3% higher risk of mortality (HR 1.03, 95% CI 1.01–1.05; p = 0.001). These results suggest that the risk of mortality rises with increasing liver stiffness.

While the studies exhibited some heterogeneity, with I2 values of 50.2% and 66.7% in the two analyses, respectively, the overall trend remained consistent. Importantly, no significant publication bias was detected through funnel plot analysis and Egger's and Begg's tests, further reinforcing the robustness of the findings.

These results emphasize the critical need for early detection and management of liver fibrosis in NAFLD patients. Identifying and addressing liver fibrosis in its early stages could potentially reduce the mortality risk associated with this increasingly prevalent condition. Healthcare providers may consider integrating LSM measurements into routine assessments for NAFLD patients to better identify those at higher risk of adverse outcomes, thus enabling timely interventions and improving patient outcomes. 

Source:

Ciardullo, S., Muraca, E., Zerbini, F., & Perseghin, G. (2023). Liver stiffness is associated with all‐cause mortality in patients with NAFLD: A systematic review and meta‐analysis. In Liver International. Wiley. https://doi.org/10.1111/liv.15742