P65 Prognostic non-invasive biomarkers for all-cause mortality in non-alcoholic fatty liver disease: systematic review and meta-analysis

IntroductionNon-alcoholic fatty liver disease (NAFLD) represents a growing public health concern, with patients having higher risk of morbidity and mortality. The aim of this systematic review was to evaluate available evidence on the use of non-invasive test(s) as prognostic factors for mortality in NAFLD.MethodsWe performed electronic searches of Medline and Embase (Ovid) until 7th January 2021 of studies in NAFLD populations. Prognostic markers included serum biomarkers, non-invasive scoring systems, and non-invasive imaging. Outcomes included all-cause, and cause-specific mortality. We conducted a systematic review and a meta-analysis of non-invasive scoring systems for predicting all-cause and cardiovascular mortality, calculating pooled hazard ratios and 95% confidence (STATA 16.1).ResultsSearches identified 2850 studies – 24 were included. 16 studies reported non-invasive scoring systems, 10 studies reported individual biomarkers, and 1 study reported imaging modalities. 4 studies (6,324 participants) had data available for inclusion in the analysis. The non-invasive scoring system that performed best at predicting all-cause mortality was NFS [pHR 3.07 (1.62-5.83)], followed by FIB4 [pHR 3.06 (1.54-6.07)], BARD [pHR 2.87 (1.27-6.46)], and APRI [pHR 1.90 (1.32-2.73)]. NFS was also associated with cardiovascular-related mortality [pHR 3.09 (1.78-5.34)].ConclusionsThis study reaffirms that non-invasive scoring systems, especially NFS, is a reliable prognostic marker of all-cause mortality in NAFLD patients. We further report that NFS can be used specifically to predict cardiovascular-related mortality. Our systematic review has highlighted several other non-invasive prognostic markers for mortality in NAFLD. These findings can inform clinical practice in risk stratifying and targeting NAFLD patients.