Disease State Transition Probabilities Across the Spectrum of NAFLD: A Systematic Review and Meta-Analysis of Paired Biopsy or Imaging Studies,Clinical Gastroenterology and Hepatology

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Disease State Transition Probabilities Across the Spectrum of NAFLD: A Systematic Review and Meta-Analysis of Paired Biopsy or Imaging Studies
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2022-08-04 , DOI: 10.1016/j.cgh.2022.07.033
Phuc Le ₁ , Julia Yang Payne ₂ , Lu Zhang ₃ , Abhishek Deshpande ₁ , Michael B Rothberg ₁ , Naim Alkhouri ₄ , William Herman ₅ , Adrian V Hernandez ₆ , Mary Schleicher ₇ , Wen Ye ₈ , Srinivasan Dasarathy ₉

Affiliation

Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio.
Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Department of Hepatology, Arizona Liver Health, Tucson, Arizona.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan.
Health Outcomes, Policy, and Evidence Synthesis Group, University of Connecticut School of Pharmacy, Storrs, Connecticut; Unidad de Revisiones Sistemáticas y Meta-Análisis, Universidad San Ignacio de Loyola, Lima, Peru.
The Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio.
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
Department of Inflammation and Immunity, Lerner Research Institute, Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.

Background & Aims

We conducted a meta-analysis to summarize the rates of progression to and regression of nonalcoholic fatty liver (NAFL), nonalcoholic steatohepatitis (NASH), and fibrosis in adults with nonalcoholic fatty liver disease (NAFLD).

Methods

We searched PubMed/Medline and 4 other databases from 1985 through 2020. We included observational studies and randomized controlled trials in any language that used liver biopsy or imaging to diagnose NAFLD in adults with a follow-up period ≥48 weeks. Rates were calculated as incident cases per 100 person-years and pooled using the random-effects Poisson distribution model. Heterogeneity was assessed using the I² statistic.

Results

We screened 9744 articles and included 54 studies involving 26,738 patients. Among observational studies, 20% of healthy adults developed NAFL (incidence rate, 4.8/100 person-years) while 21% of people with fatty liver had resolution of NAFL (incidence rate, 2.4/100 person-years) after a median of approximately 4.5 years. In addition, 31% of patients developed NASH after 4.7 years (incidence rate, 7.4/100 person-years), whereas in 29% of those with NASH, resolution occurred after a median of 3.5 years (incidence rate, 5.1/100 person-years). Time to progress by 1 fibrosis stage was 9.9, 10.3, 13.3, and 22.2 years for F0, F1, F2, and F3, respectively. Time to regress by 1 stage was 21.3, 12.5, 20.4, and 40.0 years for F4, F3, F2, and F1, respectively. Rates estimated from randomized controlled trials were higher than those from observational studies.

Conclusions

In our meta-analysis, progression to NASH was more common than regression from NASH. Rates of fibrosis progression were similar across baseline stage, but patients with advanced fibrosis were more likely to regress than those with mild fibrosis.

中文翻译：

NAFLD 范围内的疾病状态转变概率：配对活检或影像学研究的系统回顾和荟萃分析

背景与目标

我们进行了一项荟萃分析，总结了成人非酒精性脂肪肝 (NAFLD) 的非酒精性脂肪肝 (NAFL)、非酒精性脂肪性肝炎 (NASH) 和纤维化的进展和消退率。

方法

我们检索了 1985 年至 2020 年的 PubMed/Medline 和其他 4 个数据库。我们纳入了任何语言的观察性研究和随机对照试验，使用肝活检或影像学诊断成人 NAFLD，随访时间≥48 周。发生率按每 100 人年的事故案例数计算，并使用随机效应泊松分布模型进行汇总。使用 I ²统计量评估异质性。

结果

我们筛选了 9744 篇文章，纳入了涉及 26,738 名患者的 54 项研究。在观察性研究中，20% 的健康成年人出现 NAFL（发病率，4.8/100 人年），而 21% 的脂肪肝患者在中位数大约4.5年。此外，31% 的患者在 4.7 年后出现 NASH（发病率为 7.4/100 人年），而 29% 的 NASH 患者在中位 3.5 年后出现缓解（发病率为 5.1/100 人年）。年）。 F0、F1、F2 和 F3 进展到 1 个纤维化阶段的时间分别为 9.9 年、10.3 年、13.3 年和 22.2 年。 F4、F3、F2 和 F1 回归 1 阶段的时间分别为 21.3 年、12.5 年、20.4 年和 40.0 年。随机对照试验估计的发生率高于观察性研究的估计发生率。