The role of noninvasive scoring systems for predicting cardiovascular disease risk in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis

Yi, Mengshi; Peng, Wei; Teng, Fei; Kong, Qingyan; Chen, Zhe-Yu

doi:10.1097/meg.0000000000002462

Cited by 7 publications

(6 citation statements)

References 38 publications

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“…The three markers have been used to predict liver-related outcomes [18][19][20] and extrahepatic events, including cardiovascular diseases, in NAFLD patients. [21][22][23] Additional applications of seromarkers, such as the enhanced liver fibrosis (ELF) score 24 or FibroTest 25 may add value to the diagnosis of liver fibrosis. However, testing of the extracellular matrix is often on a research basis, and the cost-benefit may be offset and impractical in community screening.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the serum albumin level, which is associated with liver functional reserve, two additional metabolic factors, body mass index and fasting plasma glucose, were added to increase its predictive value. The three markers have been used to predict liver‐related outcomes 18–20 and extrahepatic events, including cardiovascular diseases, in NAFLD patients 21–23 . Additional applications of seromarkers, such as the enhanced liver fibrosis (ELF) score 24 or FibroTest 25 may add value to the diagnosis of liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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Performance of noninvasive seromarkers in predicting liver fibrosis among MAFLD patients with or without viral hepatitis

Huang,

Liang,

Wang

et al. 2024

The Kaohsiung J of Med Scie

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The accuracy of noninvasive seromarkers in predicting liver fibrosis in metabolic dysfunction‐associated fatty liver disease (MAFLD) patients with or without viral hepatitis is elusive. The AST to platelet ratio index (APRI), fibrosis‐4 index (FIB‐4), and NAFLD fibrosis score (NFS) were assessed in 871 MAFLD patients who received elastography in a viral hepatitis‐endemic area. The area under the receiver operating characteristic (AUROC) curve increased substantially with increasing fibrotic stage across the three biomarkers. APRI (AUROC range 0.73–0.80) and FIB‐4 (AUROC range 0.66–0.82) performed better than NFS (AUROC range 0.63–0.75). When patients were divided into viral and non‐viral MAFLD groups, a better AUROC of APRI (range 0.76–0.80) and FIB‐4 (range 0.68–0.78) than NFS (range 0.62–70) existed only in viral MALFD but not in non‐viral MAFLD. Regarding the NFS, the AUROC was higher in non‐viral MAFLD (range 0.69–0.86) and outperformed viral MAFLD at all fibrotic stages. The accuracy in predicting liver fibrosis increased with the advancement of liver disease for the three biomarkers. NFS exerted better diagnostic accuracy in non‐viral than in viral MAFLD patients across different fibrotic stages. The best accuracy was 91.1% using the cutoff value of −9.98 for the NFS in predicting liver cirrhosis in non‐viral MAFLD patients. The APRI and FIB‐4 performed better than the NFS in predicting liver fibrosis in MAFLD as a whole. The suboptimal performance and accuracy of the NFS existed only in viral MAFLD patients. Caution should be taken when assessing the NFS in MAFLD patients with viral hepatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Performance of noninvasive seromarkers in predicting liver fibrosis among MAFLD patients with or without viral hepatitis

Huang,

Liang,

Wang

et al. 2024

The Kaohsiung J of Med Scie

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“…Additionally, Han et al demonstrated that significant fibrosis, as defined by the NFS and Fib-4, was associated with an increased risk of atherosclerotic CVD in patients with NAFLD (aOR = 2.38; p < 0.001) [ 30 ]. In a meta-analysis, Fib-4 and NFS, rather than the AST-to-platelet ratio index, might be a significant noninvasive fibrosis scoring system for estimating higher CVD events in patients with NAFLD [ 33 ]. In another study, high liver fibrosis scores, as defined by low FIB-4 and NFS COVs, were associated with an approximately two-fold increased adjusted risk of CVD events (cardiovascular death, nonfatal myocardial infarction, and ischemic stroke) in patients who underwent coronary interventions [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of Cardiac Symptoms and Electrocardiographic Abnormalities for Advanced Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

Kang

Kim

2023

Medicina

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Background and Objectives: Advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) can be a major predictor of cardiovascular disease (CVD) events and cardiac complications. However, the clinical significance of cardiac symptoms and abnormal electrocardiography (ECG) findings in patients with NAFLD associated with advanced liver fibrosis is unclear. Therefore, our study was aimed to evaluate the clinical implications based on the association between cardiac symptoms with ECG abnormalities for advanced liver fibrosis in patients with NAFLD. Materials and Methods: Of 31,795 participants who underwent health checkups, 6293 were diagnosed with NAFLD using ultrasound and inclusion criteria in a retrospective cross-sectional study. Advanced liver fibrosis was assessed based on a low NAFLD fibrosis score (NFS) and fibrosis-4 index (Fib-4) cut-off values (COVs). Cardiac data were assessed using a cardiac symptom questionnaire and 12-lead electrocardiography (ECG). Results: Among 6293 NAFLD patients with NAFLD, 304 (4.8%) experienced cardiac symptoms. NFS and Fib-4 indicated higher rates of advanced fibrosis in the cardiac-symptomatic group than in the non-symptomatic group (NFS: 7.3 vs. 4.1%; Fib-4: 7.8 vs. 3.7%; both p < 0.001). Cardiac symptoms were independently associated with advanced liver fibrosis using a step-wise-adjusted model and NFS and Fib-4 (final adjusted odds ratio (aOR), 1.40; 95% CI, 1.06–1.85; p = 0.018 for NFS; aOR, 1.67; 95%, 1.30–2.15; p < 0.001 for Fib-4). Cardiac symptoms with abnormal ECG findings independently predicted advanced liver fibrosis (aOR, 2.43; 95% CI, 1.72–3.39; p < 0.001 for NFS; aOR, 3.02; 95% CI, 2.19–4.15; p < 0.001 for Fib-4). Conclusions: Patients who have had cardiac symptoms and some ECG abnormalities may have a higher association with advanced liver fibrosis.

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“…Despite growing awareness of the cardiovascular implications of MASLD, there is ongoing debate regarding the optimal strategy for assessing CVD risk in affected individuals. While traditional risk factors for CVD are well-established [10] , there is increasing recognition of the importance of incorporating liver-specific parameters into CVD risk assessment algorithms for MASLD patients [11][12][13] . These hepatological parameters may offer unique insights into the complex interplay between metabolic dysfunction, steatotic liver disease (SLD), and cardiovascular health.…”

Section: Introductionmentioning

confidence: 99%

Perspective article: determinants and assessment of cardiovascular risk in steatotic liver disease owing to metabolic dysfunction-addressing the challenge

Jamalinia,

Lonardo

2024

Metab Target Organ Damage

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Metabolic dysfunction-associated steatotic liver disease (MASLD) stands as an independent risk factor for cardiovascular disease (CVD), which is the leading cause of mortality among MASLD patients. The diverse spectrum of cardio-nephro-metabolic and vascular manifestations inherent in MASLD highlights the complex profile of CVD risk associated with this condition. However, current approaches to assessing CVD risk in MASLD lack specificity, predominantly relying on traditional markers. Although it is widely accepted that patients with advanced fibrosis are more prone to CVD risk, recent evidence suggests that this isolated focus may overlook the remarkable phenotypic variability of this CVD risk across the entire MASLD population. Emerging data indicate a progressive escalation of CVD risk in parallel with the severity of MASLD, highlighting the need for precise disease staging to inform accurate risk assessment. To address this challenge, we propose a novel sequential approach to CVD risk assessment in MASLD. While traditional CVD risk factors remain essential, incorporating liver-specific parameters enhances risk stratification and guides targeted interventions to mitigate the substantial burden of cardiovascular disease in this vulnerable population. This approach involves initial screening using FIB-4 and NAFLD fibrosis score, followed by assessment of liver fibrosis with imaging-based non-invasive techniques in individuals at intermediate-high risk for advanced fibrosis and liver fat quantification in low-risk individuals. Future prospective investigations should focus on the simultaneous use of liver biomarkers and imaging modalities to evaluate, in a sex-specific manner, the efficacy of the proposed approach and to determine optimal thresholds of liver fibrosis and steatosis for optimal CVD risk assessment.

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The role of noninvasive scoring systems for predicting cardiovascular disease risk in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis

Cited by 7 publications

References 38 publications

Performance of noninvasive seromarkers in predicting liver fibrosis among MAFLD patients with or without viral hepatitis

Performance of noninvasive seromarkers in predicting liver fibrosis among MAFLD patients with or without viral hepatitis

Clinical Implications of Cardiac Symptoms and Electrocardiographic Abnormalities for Advanced Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

Perspective article: determinants and assessment of cardiovascular risk in steatotic liver disease owing to metabolic dysfunction-addressing the challenge

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