Predicting clinical outcomes in people with NAFLD: no need for a crystal ball?

Abstract

A key challenge in the management of non-alcoholic fatty liver disease (NAFLD), one of the most common chronic liver diseases globally, is to identify people at highest risk of progression to advanced liver disease. 1 Younossi ZM Non-alcoholic fatty liver disease—a global public health perspective. J Hepatol. 2019; 70: 531-544 Summary Full Text Full Text PDF PubMed Scopus (1051) Google Scholar Early detection is crucial so that individuals who are at risk can be offered interventions and appropriate care before they develop liver-related complications. The most important predictor of progression to advanced liver disease and mortality in individuals with NAFLD is the extent of liver fibrosis. 2 Dulai PS Singh S Patel J et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017; 65: 1557-1565 Crossref PubMed Scopus (1050) Google Scholar Historically, liver biopsy was the only reliable method to assess liver fibrosis. However, it has a number of limitations (eg, cost, invasiveness, sampling bias, and intra-observer and inter-observer variability) and is not a suitable test for screening or monitoring liver disease progression. In clinical practice, non-invasive tests are increasingly used to provide prognostic information about liver disease severity. 3 Sanyal AJ Castéra L Wai-Sun Wong V Non-invasive assessment of liver fibrosis in NAFLD. Clin Gastroenterol Hepatol. 2023; (published online April 14.)https://doi.org/10.1016/j.cgh.2023.03.042 Summary Full Text Full Text PDF Google Scholar The individual participant data meta-analysis reported by Ferenc E Mózes and colleagues in The Lancet Gastroenterology & Hepatology4 Mózes FE Lee JA Vali Y et al. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2023; (published online June 5.)https://doi.org/10.1016/S2468-1253(23)00141-3 Google Scholar shows that non-invasive tests can also provide prognostic information about key clinical outcomes. 4 Mózes FE Lee JA Vali Y et al. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2023; (published online June 5.)https://doi.org/10.1016/S2468-1253(23)00141-3 Google Scholar Their analysis compared the performance of three non-invasive tests and liver biopsy in predicting a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, and cirrhosis complications in patients with NAFLD. Non-invasive tests were as good as liver biopsy as predictors of clinical outcomes after adjusting for potential confounders. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysisSimple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. Full-Text PDF Open Access