Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis

Abstract

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.

Keywords: NAFLD fibrosis score; cardiovascular disease; fibrosis-4 score; liver fibrosis; meta-analysis.