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

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 163; no. 4; pp. 1079 - 1089.e5
• Main Authors: Ajmera, Veeral, Kim, Beom Kyung, Yang, Kun, Majzoub, Abdul M., Nayfeh, Tarek, Tamaki, Nobuharu, Izumi, Namiki, Nakajima, Atsushi, Idilman, Ramazan, Gumussoy, Mesut, Oz, Digdem Kuru, Erden, Ayse, Quach, Natalie E., Tu, Xin, Zhang, Xinlian, Noureddin, Mazen, Allen, Alina M., Loomba, Rohit
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2022
• Subjects: Ascites; Cirrhosis; Nonalcoholic Fatty Liver Disease; Portal Hypertension; Varices; MRE; Portal Hypertension; NAFLD; OR; CI; LSM; HCC; HR; Cirrhosis; MELD; Nonalcoholic Fatty Liver Disease; Varices; FIB-4; IPDMA; Ascites; BMI
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/j.gastro.2022.06.073

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. 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. 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. 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. [Display omitted] Liver stiffness on magnetic resonance elastography identifies patients with nonalcoholic fatty liver disease at risk for future complications including the development of ascites, varices needing treatment, hepatic encephalopathy, and hepatocellular carcinoma.