Publications

@article{Cianci2022-xi,

title = {Prognostic non-invasive biomarkers for all-cause mortality in 

 non-alcoholic fatty liver disease: A systematic review and 

 meta-analysis},

author = {Nicole Cianci and Mohsan Subhani and Trevor Hill and Amardeep Khanna and Dong Zheng and Abhishek Sheth and Colin Crooks and Guruprasad P Aithal},

year  = {2022},

date = {2022-05-01},

journal = {World J. Hepatol.},

volume = {14},

number = {5},

pages = {1025\textendash1037},

publisher = {Baishideng Publishing Group Inc.},

abstract = {BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) represents 

 a growing public health concern, with patients having higher 

 risk of morbidity and mortality. It has a considerably high 

 prevalence in the general population, estimated 20%-40% in 

 Europe, and is asymptomatic until late in the disease course. It 

 is therefore important to identify and validate tools that 

 predict hard outcomes such as mortality for use in clinical 

 practice in risk-stratifying NAFLD patients. AIM: To evaluate 

 available evidence on the use of non-invasive test(s) as 

 prognostic factors for mortality in NAFLD. METHODS: We performed 

 electronic searches of Medline and EMBASE (Ovid) until 7th 

 January 2021 of studies in NAFLD populations. Prognostic markers 

 included serum biomarkers, non-invasive scoring systems, and 

 non-invasive imaging. The population included all spectrums of 

 disease severity, including NAFLD and non-alcoholic 

 steatohepatitis (NASH). Outcomes included all-cause, and 

 cardiovascular mortality. All non-invasive tests were 

 synthesised in a narrative systematic review. Finally, we 

 conducted a meta-analysis of non-invasive scoring systems for 

 predicting all-cause and cardiovascular mortality, calculating 

 pooled hazard ratios and 95% confidence (STATA 16.1). RESULTS: 

 Database searches identified 2850 studies - 24 were included. 16 

 studies reported non-invasive scoring systems, 10 studies 

 reported individual biomarkers, and 1 study reported imaging 

 modalities. 4 studies on non-invasive scoring systems (6324 

 participants) had data available for inclusion in the 

 meta-analysis. The non-invasive scoring system that performed 

 best at predicting all-cause mortality was NAFLD fibrosis score 

 (NFS) [pHR 3.07 (1.62-5.83)], followed by fibrosis-4 index [pHR 

 3.06 (1.54-6.07)], BARD [pHR 2.87 (1.27-6.46)], and AST to 

 platelet ratio index [pHR 1.90 (1.32-2.73)]. NFS was also 

 prognostic of cardiovascular-related mortality [pHR 3.09 

 (1.78-5.34)]. CONCLUSION: This study reaffirms that non-invasive 

 scoring systems, especially NFS, are reliable prognostic markers 

 of all-cause mortality and cardiovascular mortality in NAFLD 

 patients. These findings can inform clinical practice in risk 

 stratifying NAFLD patients.},

keywords = {biomarkers, mortality, Non-invasive, Nonalcoholic fatty liver   disease, Nonalcoholic steatohepatitis, Prognosis},

pubstate = {published},

tppubtype = {article}

}