Diagnostic efficacy of serum miRNA as a non-invasive method for nonalcoholic steatohepatitis: a systematic review and meta-analysis.

Abstract

1. Background: Nonalcoholic steatohepatitis (NASH) is a key turning point in the progression of nonalcoholic fatty liver disease (NAFLD). As a non-invasive method , serum miRNA levels may provide an effective reference for the diagnosis of NASH. This article systematically reviewed related diagnostic trials to compare the difference in the efficacy of serum miRNAs in the diagnosis of NAFLD and its subtype, NASH, and identify the influencing factors. 2. Methods: We pooled the sensitivity (SEN), specificity (SPE), and area under receiver operating characteristics (AUROC) of each trail to determine the efficacy of serum miRNAs in the diagnosis of NAFLD and NASH; Clinical utility was evaluated by Fagan`s nomogram; Heterogeneity was evaluated by subgroup analysis and meta-regression. Publication bias was detected by Deek’s funnel plot. 3. Results: We included 9 articles consisting of 27 trials and 2361 cases, 1775 NAFLD patients (not distinguishing between simple steatosis and NASH) and 586 NASH patients were collected. All cases were confirmed by biopsy. For NAFLD and NASH, the pooled values were SEN (0.71 vs. 0.74), SPE (0.76 vs. 0.85) and AUROC (0.80 vs. 0.86). miRNA had a high accuracy in distinction NASH from simple steatosis with AUROC at 0.91. Among the well-studied serum miRNAs, miRNA-34a showed a moderate accuracy with the lowest heterogeneity in diagnosing NAFLD (SPE I 2 : 5.73%, SPE I 2 : 33.16%, AUROC: 0.85). According to subgroup analysis and meta-regression, lower BMI ( <30kg/m 2 ) may be a crucial source of heterogeneity and reduced the performance of serum miRNA in the diagnosis of NAFLD. 4. Conclusions: As a non-invasive method, serum miRNA should be considered a promising parameter in the diagnosis of NASH. Generally, NAFLD patients with higher BMI ( ≥ 30kg/m 2 ) are more likely to be diagnosed accurately by serum miRNA.