Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis.
Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis.
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DOI：
10.1002/hep.29085
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
Loomba R
中科院分区：
文献类型：
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作者：
Dulai PS;Singh S;Patel J;Soni M;Prokop LJ;Younossi Z;Sebastiani G;Ekstedt M;Hagstrom H;Nasr P;Stal P;Wong VW;Kechagias S;Hultcrantz R;Loomba R
肝纤维化是非酒精性脂肪性肝病（NAFLD）死亡率的最重要预测因素。尚未系统评价纤维化分期的死亡率定量风险。我们的目的是量化NAFLD中全因和肝脏相关死亡率的纤维化阶段特异性风险。通过系统回顾和荟萃分析，我们确定了5项报告纤维化分期特异性死亡率（0-4）的成人NAFLD队列研究。使用0期纤维化作为参考人群，估计全因和肝脏相关死亡率的纤维化分期特异性死亡率比（MRR）及其95%置信区间（CI）。根据PRISMA声明报告本研究。纳入了1，495例NAFLD患者，随访时间为17，452患者年。与无纤维化的NAFLD患者（0期）相比，有纤维化的NAFLD患者的全因死亡风险增加，并且该风险随着纤维化分期的增加而增加：1期，MRR，1.58（95%CI 1.19-2.11）; 2期，MRR，2.52（95%CI 1.85-3.42）; 3期，MRR，3.48（95%CI 2.51-4.83），4期，MRR，6.40（95%CI 4.11-9.95）。随着肝纤维化分期的增加，肝脏相关死亡风险呈指数增加，结果更加明显：1期，MRR，1.41（95% CI 0.17-11.95）; 2期，MRR，9.57（95% CI 1.67-54.93）; 3期，MRR，16.69（95% CI 2.92-95.36）; 4期，MRR，42.30（95% CI 3.51-510.34）。无法调整已知会影响NAFLD纤维化进展的共病或人口统计学特征，并将单纯性脂肪变性和NASH无纤维化的患者纳入参考对照组。肝脏相关死亡率的风险随着纤维化分期的增加呈指数增加。这些数据在评估每个阶段的效用和纤维化从一个阶段到另一个阶段的消退的益处方面具有重要意义。
Liver fibrosis is the most important predictor of mortality in nonalcoholic fatty liver disease (NAFLD). Quantitative risk of mortality by fibrosis stage has not been systematically evaluated. We aimed to quantify the fibrosis stage-specific risk of all-cause and liver-related mortality in NAFLD. Through a systematic review and meta-analysis, we identified 5 adult NAFLD cohort studies reporting fibrosis stage specific mortality (0–4). Using fibrosis stage 0 as a reference population, fibrosis stage-specific mortality rate ratios (MRR) with 95% confidence intervals (CI), for all-cause and liver-related mortality, were estimated. The study is reported according to the PRISMA statement. 1,495 NAFLD patients with 17,452 patient years of follow-up were included. Compared to NAFLD patients with no fibrosis (stage 0), NAFLD patients with fibrosis were at an increased risk for all-cause mortality and this risk increased with increase in the stage of fibrosis: stage 1, MRR, 1.58 (95% CI 1.19–2.11); stage 2, MRR, 2.52 (95% CI 1.85–3.42); stage 3, MRR, 3.48 (95% CI 2.51–4.83), and stage 4, MRR, 6.40 (95% CI 4.11–9.95). The results were more pronounced as the risk of liver-related mortality increased exponentially with increase in the stage of fibrosis: stage 1, MRR, 1.41 (95% CI 0.17–11.95); stage 2, MRR, 9.57 (95% CI 1.67–54.93); stage 3, MRR, 16.69 (95% CI 2.92–95.36); and stage 4, MRR, 42.30 (95% CI 3.51–510.34). Inability to adjust for co-morbid conditions or demographics known to impact fibrosis progression in NAFLD, and the inclusion of patients with simple steatosis and NASH without fibrosis in the reference comparison group. The risk of liver-related mortality increases exponentially with increase in fibrosis stage. These data have important implications in assessing utility of each stage and benefits of regression of fibrosis from one stage to another.