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.

Ajmera V., Kim B. K., Yang K., Majzoub A. M., Nayfeh T., Tamaki N., ...More

Gastroenterology, vol.163, no.4, pp.1079, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 163 Issue: 4
  • Publication Date: 2022
  • Doi Number: 10.1053/j.gastro.2022.06.073
  • Journal Name: Gastroenterology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts, EMBASE, International Pharmaceutical Abstracts, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.1079
  • Keywords: Nonalcoholic Fatty Liver Disease, Portal Hypertension, Cirrhosis, Ascites, Varices, AMERICAN ASSOCIATION, PRACTICE GUIDANCE, FIBROSIS STAGE, DIAGNOSIS, MORTALITY, MANAGEMENT, BIOPSY, NAFLD, RISK
  • Ankara University Affiliated: Yes


BACKGROUND & AIMS: Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis; however, limited data characterize its association with clinical outcomes. We conducted an individual participant data pooled meta-analysis on patients with nonalcoholic fatty liver disease to evaluate the association between liver stiffness on MRE and liver-related outcomes. METHODS: A systematic search identified 6 cohorts of adults with nonalcoholic fatty liver disease who underwent a baseline MRE and were followed for hepatic decompensation, hepatocellular carcinoma, and death. Cox and logistic regression were used to assess the association between liver stiffness on MRE and liver-related outcomes, including a composite primary outcome defined as varices needing treatment, ascites, and hepatic encephalopathy. RESULTS: This individual participant data pooled meta-analysis 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 (interquartile range) of 3 (4.2) years of follow-up, the hazard ratio for the primary outcome for MRE of 5 to 8 kPa was 11.0 (95% confidence interval [CI]: 7.03-17.1, P < .001) and for >= 8 kPa was 15.9 (95% CI: 9.32-27.2, P < .001), compared with those with MRE <5 kPa. The MEFIB index (defined as positive when MRE >= 3.3 kPa and Fibrosis-4 >= 1.6) had a robust association with the primary outcome with a hazard ratio 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 hepatocellular carcinoma was 0.35% for MRE <5 kPa, 5.25% for 5 to 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 Fibrosis-4 has excellent negative predictive value for hepatic decompensation. These data have important implications for clinical practice.