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

LITMUS Investigators; Ferenc E Mózes; Jenny Lee; Yasaman Vali; Osama Alzoubi; Katharina Staufer; Michael Trauner; Rafael Paternostro; Rudolf E Stauber; Adriaan G Holleboom; Anne-Marieke Van Dijk; Anne linde Mak; Jérôme Boursier; Marc De Saint Loup; Toshihide Shima; Elisabetta Bugianesi; Silvia Gaia; Angelo Armandi; null Shalimar; Monica Lupșor-Platon; Vincent Wai-Sun Wong; Guanlin Li; Grace Lai-Hung Wong; Jeremy Cobbold; Thomas Karlas; Johannes Wiegand; Giada Sebastiani; Emmanuel Tsochatzis; Antonio Liguori; Masato Yoneda; Atsushi Nakajima; Hannes Hagström; Camilla Akbari; Masashi Hirooka; Wah-Kheong Chan; Sanjiv Mahadeva; Ruveena Rajaram; Ming-Hua Zheng; Jacob George; Mohammed Eslam; Salvatore Petta; Grazia Pennisi; Mauro Viganò; Sofia Ridolfo; Guruprasad Padur Aithal; Naaventhan Palaniyappan; Dae Ho Lee; Mattias Ekstedt; Patrik Nasr

doi:10.1016/S2468-1253(23)00141-3

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

LITMUS Investigators, Ferenc E Mózes, Jenny Lee, Yasaman Vali, Osama Alzoubi, Katharina Staufer, Michael Trauner, Rafael Paternostro, Rudolf E Stauber, Adriaan G Holleboom, Anne-Marieke Van Dijk, Anne linde Mak, Jérôme Boursier, Marc De Saint Loup, Toshihide Shima, Elisabetta Bugianesi, Silvia Gaia, Angelo Armandi, Shalimar, Monica Lupșor-PlatonVincent Wai-Sun Wong, Guanlin Li, Grace Lai-Hung Wong, Jeremy Cobbold, Thomas Karlas, Johannes Wiegand, Giada Sebastiani, Emmanuel Tsochatzis, Antonio Liguori, Masato Yoneda, Atsushi Nakajima, Hannes Hagström, Camilla Akbari, Masashi Hirooka, Wah-Kheong Chan, Sanjiv Mahadeva, Ruveena Rajaram, Ming-Hua Zheng, Jacob George, Mohammed Eslam, Salvatore Petta, Grazia Pennisi, Mauro Viganò, Sofia Ridolfo, Guruprasad Padur Aithal, Naaventhan Palaniyappan, Dae Ho Lee, Mattias Ekstedt, Patrik Nasr

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.

METHODS: This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.

FINDINGS: Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.

INTERPRETATION: Simple 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.

FUNDING: Innovative Medicines Initiative 2.

Original language	English
Pages (from-to)	704-713
Number of pages	10
Journal	The Lancet Gastroenterology & Hepatology
Volume	8
Issue number	8
Early online date	5 Jun 2023
DOIs	https://doi.org/10.1016/S2468-1253(23)00141-3
Publication status	Published - Aug 2023

Bibliographical note

Acknowledgments:
This individual participant data meta-analysis has been conducted as part of the imaging study in the Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS) study. The LITMUS study is a large multicentre study aiming to evaluate biomarkers on non-alcoholic fatty liver disease. The LITMUS study is funded by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under Grant Agreement 777377. This Joint Undertaking receives support from the EU's Horizon 2020 research and innovation programme and EFPIA. This communication reflects the view of the LITMUS consortium and neither IMI nor the EU and EFPIA are liable for any use that may be made of the information contained herein. GS is supported by a Senior Salary Award from Fonds de Recherche du Quebec–Sante (#296306). FEM was partially funded by a Sir Henry Dale Fellowships awarded jointly by the Wellcome Trust and the Royal Society [221805/Z/20/Z]. DHL received a grant from KHIDI (HI14C1135), funded by the Ministry of Health & Welfare, Korea. QMA is an NIHR Senior Investigator and is supported by the Newcastle NIHR Biomedical Research Centre.

Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Keywords

Humans
Female
Middle Aged
Male
Non-alcoholic Fatty Liver Disease/complications
Diabetes Mellitus, Type 2/complications
Esophageal and Gastric Varices
Gastrointestinal Hemorrhage/complications
Liver Cirrhosis/etiology
Fibrosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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LITMUS Investigators, Mózes, F. E., Lee, J., Vali, Y., Alzoubi, O., Staufer, K., Trauner, M., Paternostro, R., Stauber, R. E., Holleboom, A. G., Van Dijk, A.-M., Mak, A. L., Boursier, J., De Saint Loup, M., Shima, T., Bugianesi, E., Gaia, S., Armandi, A., Shalimar, ... Nasr, P. (2023). 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. The Lancet Gastroenterology & Hepatology, 8(8), 704-713. https://doi.org/10.1016/S2468-1253(23)00141-3

@article{7c22e46670d5474d95e7e2340e870133,

title = "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",

abstract = "BACKGROUND: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.METHODS: This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FINDINGS: Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.INTERPRETATION: Simple 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.FUNDING: Innovative Medicines Initiative 2.",

keywords = "Humans, Female, Middle Aged, Male, Non-alcoholic Fatty Liver Disease/complications, Diabetes Mellitus, Type 2/complications, Esophageal and Gastric Varices, Gastrointestinal Hemorrhage/complications, Liver Cirrhosis/etiology, Fibrosis",

author = "{LITMUS Investigators} and M{\'o}zes, {Ferenc E} and Jenny Lee and Yasaman Vali and Osama Alzoubi and Katharina Staufer and Michael Trauner and Rafael Paternostro and Stauber, {Rudolf E} and Holleboom, {Adriaan G} and {Van Dijk}, Anne-Marieke and Mak, {Anne linde} and J{\'e}r{\^o}me Boursier and {De Saint Loup}, Marc and Toshihide Shima and Elisabetta Bugianesi and Silvia Gaia and Angelo Armandi and Shalimar and Monica Lupșor-Platon and Wong, {Vincent Wai-Sun} and Guanlin Li and Wong, {Grace Lai-Hung} and Jeremy Cobbold and Thomas Karlas and Johannes Wiegand and Giada Sebastiani and Emmanuel Tsochatzis and Antonio Liguori and Masato Yoneda and Atsushi Nakajima and Hannes Hagstr{\"o}m and Camilla Akbari and Masashi Hirooka and Wah-Kheong Chan and Sanjiv Mahadeva and Ruveena Rajaram and Ming-Hua Zheng and Jacob George and Mohammed Eslam and Salvatore Petta and Grazia Pennisi and Mauro Vigan{\`o} and Sofia Ridolfo and Aithal, {Guruprasad Padur} and Naaventhan Palaniyappan and Lee, {Dae Ho} and Mattias Ekstedt and Patrik Nasr and Philip Newsome and Stefan H{\"u}bscher",

note = "Acknowledgments: This individual participant data meta-analysis has been conducted as part of the imaging study in the Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS) study. The LITMUS study is a large multicentre study aiming to evaluate biomarkers on non-alcoholic fatty liver disease. The LITMUS study is funded by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under Grant Agreement 777377. This Joint Undertaking receives support from the EU's Horizon 2020 research and innovation programme and EFPIA. This communication reflects the view of the LITMUS consortium and neither IMI nor the EU and EFPIA are liable for any use that may be made of the information contained herein. GS is supported by a Senior Salary Award from Fonds de Recherche du Quebec–Sante (#296306). FEM was partially funded by a Sir Henry Dale Fellowships awarded jointly by the Wellcome Trust and the Royal Society [221805/Z/20/Z]. DHL received a grant from KHIDI (HI14C1135), funded by the Ministry of Health & Welfare, Korea. QMA is an NIHR Senior Investigator and is supported by the Newcastle NIHR Biomedical Research Centre. Copyright: {\textcopyright} 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.",

year = "2023",

month = aug,

doi = "10.1016/S2468-1253(23)00141-3",

language = "English",

volume = "8",

pages = "704--713",

journal = "The Lancet Gastroenterology & Hepatology",

issn = "2468-1253",

publisher = "Elsevier",

number = "8",

}

LITMUS Investigators, Mózes, FE, Lee, J, Vali, Y, Alzoubi, O, Staufer, K, Trauner, M, Paternostro, R, Stauber, RE, Holleboom, AG, Van Dijk, A-M, Mak, AL, Boursier, J, De Saint Loup, M, Shima, T, Bugianesi, E, Gaia, S, Armandi, A, Shalimar, Lupșor-Platon, M, Wong, VW-S, Li, G, Wong, GL-H, Cobbold, J, Karlas, T, Wiegand, J, Sebastiani, G, Tsochatzis, E, Liguori, A, Yoneda, M, Nakajima, A, Hagström, H, Akbari, C, Hirooka, M, Chan, W-K, Mahadeva, S, Rajaram, R, Zheng, M-H, George, J, Eslam, M, Petta, S, Pennisi, G, Viganò, M, Ridolfo, S, Aithal, GP, Palaniyappan, N, Lee, DH, Ekstedt, M & Nasr, P 2023, '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', The Lancet Gastroenterology & Hepatology, vol. 8, no. 8, pp. 704-713. https://doi.org/10.1016/S2468-1253(23)00141-3

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. / LITMUS Investigators; Mózes, Ferenc E; Lee, Jenny et al.
In: The Lancet Gastroenterology & Hepatology, Vol. 8, No. 8, 08.2023, p. 704-713.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease

T2 - an individual participant data meta-analysis

AU - LITMUS Investigators

AU - Mózes, Ferenc E

AU - Lee, Jenny

AU - Vali, Yasaman

AU - Alzoubi, Osama

AU - Staufer, Katharina

AU - Trauner, Michael

AU - Paternostro, Rafael

AU - Stauber, Rudolf E

AU - Holleboom, Adriaan G

AU - Van Dijk, Anne-Marieke

AU - Mak, Anne linde

AU - Boursier, Jérôme

AU - De Saint Loup, Marc

AU - Shima, Toshihide

AU - Bugianesi, Elisabetta

AU - Gaia, Silvia

AU - Armandi, Angelo

AU - Shalimar, null

AU - Lupșor-Platon, Monica

AU - Wong, Vincent Wai-Sun

AU - Li, Guanlin

AU - Wong, Grace Lai-Hung

AU - Cobbold, Jeremy

AU - Karlas, Thomas

AU - Wiegand, Johannes

AU - Sebastiani, Giada

AU - Tsochatzis, Emmanuel

AU - Liguori, Antonio

AU - Yoneda, Masato

AU - Nakajima, Atsushi

AU - Hagström, Hannes

AU - Akbari, Camilla

AU - Hirooka, Masashi

AU - Chan, Wah-Kheong

AU - Mahadeva, Sanjiv

AU - Rajaram, Ruveena

AU - Zheng, Ming-Hua

AU - George, Jacob

AU - Eslam, Mohammed

AU - Petta, Salvatore

AU - Pennisi, Grazia

AU - Viganò, Mauro

AU - Ridolfo, Sofia

AU - Aithal, Guruprasad Padur

AU - Palaniyappan, Naaventhan

AU - Lee, Dae Ho

AU - Ekstedt, Mattias

AU - Nasr, Patrik

AU - Newsome, Philip

AU - Hübscher, Stefan

N1 - Acknowledgments: This individual participant data meta-analysis has been conducted as part of the imaging study in the Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS) study. The LITMUS study is a large multicentre study aiming to evaluate biomarkers on non-alcoholic fatty liver disease. The LITMUS study is funded by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under Grant Agreement 777377. This Joint Undertaking receives support from the EU's Horizon 2020 research and innovation programme and EFPIA. This communication reflects the view of the LITMUS consortium and neither IMI nor the EU and EFPIA are liable for any use that may be made of the information contained herein. GS is supported by a Senior Salary Award from Fonds de Recherche du Quebec–Sante (#296306). FEM was partially funded by a Sir Henry Dale Fellowships awarded jointly by the Wellcome Trust and the Royal Society [221805/Z/20/Z]. DHL received a grant from KHIDI (HI14C1135), funded by the Ministry of Health & Welfare, Korea. QMA is an NIHR Senior Investigator and is supported by the Newcastle NIHR Biomedical Research Centre. Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

PY - 2023/8

Y1 - 2023/8

N2 - BACKGROUND: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.METHODS: This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FINDINGS: Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.INTERPRETATION: Simple 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.FUNDING: Innovative Medicines Initiative 2.

AB - BACKGROUND: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.METHODS: This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FINDINGS: Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.INTERPRETATION: Simple 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.FUNDING: Innovative Medicines Initiative 2.

KW - Humans

KW - Female

KW - Middle Aged

KW - Male

KW - Non-alcoholic Fatty Liver Disease/complications

KW - Diabetes Mellitus, Type 2/complications

KW - Esophageal and Gastric Varices

KW - Gastrointestinal Hemorrhage/complications

KW - Liver Cirrhosis/etiology

KW - Fibrosis

U2 - 10.1016/S2468-1253(23)00141-3

DO - 10.1016/S2468-1253(23)00141-3

M3 - Article

C2 - 37290471

SN - 2468-1253

VL - 8

SP - 704

EP - 713

JO - The Lancet Gastroenterology & Hepatology

JF - The Lancet Gastroenterology & Hepatology

IS - 8

ER -

LITMUS Investigators, Mózes FE, Lee J, Vali Y, Alzoubi O, Staufer K 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. The Lancet Gastroenterology & Hepatology. 2023 Aug;8(8):704-713. Epub 2023 Jun 5. doi: 10.1016/S2468-1253(23)00141-3

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

Abstract

Bibliographical note

Keywords

UN SDGs

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