Abstract:

Background: Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD) is a prevalent liver disease affecting 1 million people and projected to be the leading cause of liver transplantation in 2030 due to its progression of liver fibrosis. Several non-invasive scoring systems have been established to predict advanced fibrosis among MAFLD patients, namely NAFLD Fibrosis Score (NFS). Whether its performance remains useful in determining mortality risk in the MAFLD population is less clear. This study was aimed to assess the usefulness of NFS to predict mortality risk among MAFLD patients. Method: A systematic search was conducted on Pubmed, ProQuest, and ScienceDirect from inception to February 28, 2021. All studies that met the inclusion criteria investigating MAFLD patients diagnosed with biopsy or non-biopsy were included. Bias risk was assessed using The Newcastle-Ottawa Scale. The outcome was mortality risk. We used a random-effects model, and data were pooled to determine the risk ratio (RR) and its 95% CI. Meta-analysis was conducted using Review Manager 5.3. Result: 9 cohort studies comprising 21,041 MAFLD patients were included. The risk of bias was found to be low. Pooled analysis showed that high NFS (>0.676) was significantly associated with increased mortality (RR=3.14; 95%CI=2.35-4.19; p<0.0; I2=89%). The finding was more prominent in the biopsy-proven MAFLD subgroup (RR=3.75; 95%CI=2.20-6.38; p<0.00). Conclusion: High NFS is associated with an increased risk of death in MAFLD patients. 

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