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MEFIB Index Can Have an Important Role in Clinical Management


Background and aims: Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis, however, limited data characterize its association with clinical outcomes. We conducted individual participant data pooled meta-analysis (IPDMA) on patients with nonalcoholic fatty liver disease (NAFLD) to evaluate the association between liver stiffness (LS) on MRE and liver-related outcomes. Methods: A systematic search identified 6 cohorts of adults with NAFLD who underwent a baseline MRE and were followed for hepatic decompensation, hepatocellular carcinoma (HCC) and death. Cox- and logistic-regression were used to assess the association between LS on MRE and liver-related outcomes including a composite primary outcome defined as varices needing treatment, ascites and hepatic encephalopathy. Results: This IPDMA included 2018 patients (53% women) with a mean (± standard deviation) age of 57.8 (±14) years and MRE at baseline of 4.15 (±2.19) kPa, respectively. Among 1707 patients with available longitudinal data with a median (IQR) of 3 (4.2) years of follow-up, the hazard ratio (HR) for the primary outcome for MRE between 5-8 kPa was 11.0 (95%CI: 7.03-17.1, P < .001) and for ≥ 8 kPa was 15.9 (95%CI:9.32-27.2, P < .001), compared to those with MRE < 5 kPa. The MEFIB index (defined as positive when MRE ≥ 3.3kPa and FIB-4 ≥ 1.6) had a robust association with the primary outcome with a HR of 20.6 (95% CI: 10.4-40.8, P < .001) and a negative MEFIB had a high negative predictive value for the primary outcome, 99.1% at 5 years. The 3-year risk of incident HCC was 0.35% for MRE<5 kPa, 5.25% for 5-8 kPa, and 5.66% for MRE≥8 kPa, respectively. Conclusion: Liver stiffness assessed by MRE is associated with liver-related events and the combination of MRE and FIB-4 has excellent negative predictive value for hepatic decompensation. These data have important implications for clinical practice.


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