Journal
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
Volume 52, Issue 11, Pages -Publisher
WILEY
DOI: 10.1111/eci.13855
Keywords
cardiovascular disease; fibrosis-4 score; liver fibrosis; meta-analysis; NAFLD fibrosis score
Funding
- NaturalScience Foundation of Jiangxi Province [20192ACBL21037, 202004BCJL23049, 202002BAB216022]
- National Natural Science Foundation of China [82160371, 82100869, 21866019, 82100347]
- China Postdoctoral Science Foundation [2021M703724]
- National High Technology Research and Development Program of Guangzhou [20180304001, 2019GZR110406004]
- Basic Scientific Research Projects of Colleges and Universities of Liaoning Province [LQN2017ST03]
- Natural Science Foundation of Guangdong Province [2022A1515010582]
- Science and Technology Projects in Guangzhou [202102010007]
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Higher levels of liver fibrosis scores are associated with increased risk of cardiovascular events, cardiovascular mortality, and all-cause mortality in patients with cardiovascular disease.
Background In patients with nonalcoholic fatty liver disease, liver fibrosis was associated with a higher risk of cardiovascular events. However, the relationship between liver fibrosis scores and clinical outcomes in patients with cardiovascular disease remains unclear. Methods Searching from PubMed, EMBASE and Cochrane Library databases yielded cohort studies that reported adjusted effect size between liver fibrosis scores (Fibrosis-4 score [FIB-4] or NAFLD fibrosis score [NFS]) and prognosis in patients with cardiovascular disease. The effect size was computed using a random-effects model. Results This meta-analysis included twelve cohort studies involving 25,252 patients with cardiovascular disease. Participants with the highest baseline level of FIB-4 or NFS had a significantly increased risk of cardiovascular events (FIB-4, HR: 1.75, 95% CI: 1.53-2.00, I-2 = 0%; NFS, HR: 1.92, 95% CI: 1.50-2.47, I-2 = 47%). This finding was consistent with the analysis of FIB-4 or NFS as a continuous variable (per 1-unit increment FIB-4, HR: 1.15, 95% CI: 1.06-1.24, I-2 = 72%; NFS, HR: 1.15, 95% CI: 1.07-1.24, I-2 = 71%). Furthermore, participants with the highest levels of FIB-4 or NFS had a greater risk of cardiovascular mortality (FIB-4, HR: 2.07, 95% CI: 1.19-3.61, I-2 = 89%; NFS, HR: 3.72, 95% CI: 2.62-5.29, I-2 = 60%) and all-cause mortality (FIB-4, HR: 1.81, 95% CI: 1.24-2.66, I-2 = 90%; NFS, HR: 3.49, 95% CI: 2.82-4.31, I-2 = 25%). This result was also consistent as a continuous variable. Conclusion Higher levels of FIB-4 and NFS are related to an increased risk of cardiovascular events, cardiovascular mortality and all-cause mortality in patients with cardiovascular disease.
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