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Simple non‐invasive scoring systems and histological scores in predicting mortality in patients with non‐alcoholic fatty liver disease: A systematic review and meta‐analysis
Author(s) -
Liu ChangHai,
Ampuero Javier,
Pavlides Michael,
Wong Vincent WaiSun,
Fan JianGao,
Bai Lang,
Li Hong,
Wu DongBo,
Zhou LingYun,
Du LingYao,
Yang TianKuo,
Jiang Wei,
Shi Ying,
GilGómez Antonio,
Zhang WenTing,
Liang JiaXu,
RomeroGómez Manuel,
Tang Hong
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15431
Subject(s) - medicine , hazard ratio , fatty liver , gastroenterology , cirrhosis , decompensation , hepatology , incidence (geometry) , mortality rate , confidence interval , liver disease , alcoholic liver disease , disease , physics , optics
Background and Aim There is debate among the hepatology community regarding the simple non‐invasive scoring systems and histological scores (even it was developed for histological classification) in predicting clinical outcomes in patients with non‐alcoholic fatty liver disease (NAFLD). This study aimed to determine whether the presence of simple non‐invasive scoring systems and histological scores could predict all‐cause mortality, liver‐related mortality, and liver disease decompensation (liver failure, cirrhosis, hepatocellular carcinoma, or decompensated liver disease). Methods The pooled hazard ratio of prognostic factors and incidence rate per 1000 person‐years in patients with NAFLD was calculated and further adjusted by two different models of handling the duplicated data. Results A total of 19 longitudinal studies were included. Most simple non‐invasive scoring systems (Fibrosis‐4 Score, BARD, and aspartate aminotransferase‐to‐platelet ratio index ) and histological scores (NAFLD activity score, Brunt, and "steatosis, activity, and fibrosis" ) failed in predicting mortality, and only the NAFLD fibrosis score > 0.676 showed prognostic ability to all‐cause mortality (four studies, 7564 patients, 118 352 person‐years followed up, pooled hazard ratio 1.44, 95% confidence interval [CI] 1.05–1.96). The incidence rate per 1000 person‐years of all‐cause mortality, liver‐related mortality, cardiovascular‐related mortality, and liver disease decompensation resulted in a pooled incidence rate per 1000 person‐years of 22.65 (14 studies, 95% CI 9.62–53.31), 3.19 (7 studies, 95% CI 1.14–8.93), 6.02 (6 studies, 95% CI 4.69–7.74), and 11.46 (4 studies, 95% CI 5.33–24.63), respectively. Conclusion Non‐alcoholic fatty liver disease fibrosis score showed promising prognostic value to all‐cause mortality. Most present simple non‐invasive scoring systems and histological scores failed to predict clinical outcomes.