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Abstract Details
Liver Stiffness on Magnetic Resonance Elastography and the MEFIB Index and Liver-Related Outcomes in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Individual Participants
Gastroenterology. 2022 Jul 1;S0016-5085(22)00735-1. doi: 10.1053/j.gastro.2022.06.073.Online ahead of print.
1NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA; Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA.
2NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA; Department of Internal medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
3School of Public Health, University of California, San Diego.
4Division of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, PA, USA.
5Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA.
6NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan.
7Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan.
8Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan.
9Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey.
10Ankara University School of Medicine, Department of Radiology, Ankara Turkey.
11Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA.
12Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
13NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA; Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA; School of Public Health, University of California, San Diego. Electronic address: roloomba@ucsd.edu.
Abstract
Background and aims: Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis, however, limited data characterize its association with clinical outcomes. We conducted individual participant data pooled meta-analysis (IPDMA) on patients with nonalcoholic fatty liver disease (NAFLD) to evaluate the association between liver stiffness (LS) on MRE and liver-related outcomes.
Methods: A systematic search identified 6 cohorts of adults with NAFLD who underwent a baseline MRE and were followed for hepatic decompensation, hepatocellular carcinoma (HCC) and death. Cox- and logistic-regression were used to assess the association between LS on MRE and liver-related outcomes including a composite primary outcome defined as varices needing treatment, ascites and hepatic encephalopathy.
Results: This IPDMA included 2018 patients (53% women) with a mean (± standard deviation) age of 57.8 (±14) years and MRE at baseline of 4.15 (±2.19) kPa, respectively. Among 1707 patients with available longitudinal data with a median (IQR) of 3 (4.2) years of follow-up, the hazard ratio (HR) for the primary outcome for MRE between 5-8 kPa was 11.0 (95%CI: 7.03-17.1, P < .001) and for ≥ 8 kPa was 15.9 (95%CI:9.32-27.2, P < .001), compared to those with MRE < 5 kPa. The MEFIB index (defined as positive when MRE ≥ 3.3kPa and FIB-4 ≥ 1.6) had a robust association with the primary outcome with a HR of 20.6 (95% CI: 10.4-40.8, P < .001) and a negative MEFIB had a high negative predictive value for the primary outcome, 99.1% at 5 years. The 3-year risk of incident HCC was 0.35% for MRE<5 kPa, 5.25% for 5-8 kPa, and 5.66% for MRE≥8 kPa, respectively.
Conclusion: Liver stiffness assessed by MRE is associated with liver-related events and the combination of MRE and FIB-4 has excellent negative predictive value for hepatic decompensation. These data have important implications for clinical practice.