An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography

作者：Jiaxu Liang, Javier Ampuero, Hao Niu, Kento Imajo, Mazen Noureddin, Jaideep Behari, Dae Ho Lee, Richard L. Ehman, Fredrik Rorsman, Johan Vessby, Juan Ramón Lacalle-Remigio, Ferenc E. Mózes, Michael Pavlides, Quentin M. Anstee, Stephen A. Harrison, Javier Castell, Rohit Loomba, Manuel Romero‐Gómez · 发表于：Journal of Hepatology · 年份：2023 · DOI：10.1016/j.jhep.2023.04.025 · 被引用次数：116 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Liver Diseases and Immunity

BACKGROUND & AIMS: We conducted an individual patient data meta-analysis to establish stiffness cut-off values for magnetic resonance elastography (MRE) in staging liver fibrosis and to assess potential confounding factors. METHODS: A systematic review of the literature identified studies reporting MRE data in patients with NAFLD. Data were obtained from the corresponding authors. The pooled diagnostic cut-off value for the various fibrosis stages was determined in a two-stage meta-analysis. Multilevel modelling methods were used to analyse potential confounding factors influencing the diagnostic accuracy of MRE in staging liver fibrosis. RESULTS: Eight independent cohorts comprising 798 patients were included in the meta-analysis. The area under the receiver operating characteristic curve (AUROC) for MRE in detecting significant fibrosis was 0.92 (sensitivity, 79%; specificity, 89%). For advanced fibrosis, the AUROC was 0.92 (sensitivity, 87%; specificity, 88%). For cirrhosis, the AUROC was 0.94 (sensitivity, 88%, specificity, 89%). Cut-offs were defined to explore concordance between MRE and histopathology: ≥F2, 3.14 kPa (pretest probability, 39.4%); ≥F3, 3.53 kPa (pretest probability, 24.1%); and F4, 4.45 kPa (pretest probability, 8.7%). In generalized linear mixed model analysis, histological steatohepatitis with higher inflammatory activity (odds ratio 2.448, 95% CI 1.180-5.079, p <0.05) and high gamma-glutamyl transferase (GGT) concentration (>120U/L) (odds ratio 3.388,...