Type 2 diabetes, hepatic decompensation, and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: an individual participant-level data meta-analysis
作者：Daniel Q. Huang, Nabil Noureddin, Veeral Ajmera, Maral Amangurbanova, Ricki Bettencourt, Emily Truong, Tolga Gidener, Harris Siddiqi, Abdul M. Majzoub, Tarek Nayfeh, Nobuharu Tamaki, Namiki Izumi, Masato Yoneda, Atsushi Nakajima, Ramazan Idılman, Mesut Gümüşsoy, Diğdem Kuru Öz, Ayşe Erden, Alina M. Allen, Mazen Noureddin, Rohit Loomba · 发表于：The Lancet. Gastroenterology & hepatology · 年份：2023 · DOI：10.1016/s2468-1253(23)00157-7 · 被引用次数：177 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Diabetes, Cardiovascular Risks, and Lipoproteins
BACKGROUND: Data are scarce regarding the development of hepatic decompensation in patients with non-alcoholic fatty liver disease (NAFLD) with and without type 2 diabetes. We aimed to assess the risk of hepatic decompensation in people with NAFLD with and without type 2 diabetes. METHODS: We did a meta-analysis of individual participant-level data from six cohorts in the USA, Japan, and Turkey. Included participants had magnetic resonance elastography between Feb 27, 2007, and June 4, 2021. Eligible studies included those with liver fibrosis characterisation by magnetic resonance elastography, longitudinal assessment for hepatic decompensation and death, and included adult patients (aged ≥18 years) with NAFLD, for whom data were available regarding the presence of type 2 diabetes at baseline. The primary outcome was hepatic decompensation, defined as ascites, hepatic encephalopathy, or variceal bleeding. The secondary outcome was the development of hepatocellular carcinoma. We used competing risk regression using the Fine and Gray subdistribution hazard ratio (sHR) to compare the likelihood of hepatic decompensation in participants with and without type 2 diabetes. Death without hepatic decompensation was a competing event. FINDINGS: (SD 7·4). Among 1737 participants (602 with type 2 diabetes and 1135 without type 2 diabetes) with available longitudinal data, 105 participants developed hepatic decompensation over a median follow-up time of 2·8 years (IQR 1·4-5·5). Participan...