Liver stiffness is associated with all‐cause mortality in patients with NAFLD: A systematic review and meta‐analysis

Abstract

AbstractBackground and AimsSeveral studies reported an association between liver stiffness measurement (LSM) obtained through vibration‐controlled transient elastography (VCTE) and all‐cause mortality in patients with nonalcoholic fatty liver disease (NAFLD). The objective of this systematic review and meta‐analysis was to summarize available evidence on the nature and magnitude of this association.MethodsWe systematically searched PubMed‐MEDLINE and Scopus up to April 2023 for observational cohort studies in which LSM was measured with VCTE in patients with NAFLD or in general population settings, with a follow‐up ≥1 year and with available data on all‐cause mortality. Measures of association from individual studies were meta‐analysed using random effects models. Of the 517 titles initially scrutinized, we included seven studies with data on 18 771 participants (47.1% male) and a mean follow‐up of 3.6 years. We included effect estimates obtained in the models with the highest degree of adjustment for potential confounders available in each study.ResultsWhen analysed as a categorical variable based on specific LSM cut‐offs, liver fibrosis was associated with an increased risk of all‐cause death (HR 2.10, 95% CI 1.56–2.83; test for overall effect z = 4.919, p < 0.001). Results were consistent when LSM was considered as a continuous variable (HR for 1 kPa increase: 1.03, 95% CI 1.01–1.05; test for overall effect z = 3.341, p = 0.001). There was borderline significant heterogeneity among the studies (I2 = 50.2% and I2 = 66.7% in the two analyses, respectively). No significant publication bias was detected by funnel plot analysis and Egger's and Begg's tests.ConclusionThe present meta‐analysis indicates that LSM, as a proxy of liver fibrosis, is independently and directly associated with a higher mortality risk in patients with NAFLD.