The utility of NAFLD fibrosis score for prediction of mortality among patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis of cohort study.

Background: Nonalcoholic fatty liver disease (NAFLD) is a common liver disorder worldwide. Several noninvasive diagnostic scoring systems have been developed to determine the severity of liver fibrosis and to predict long-term outcome of patients with NAFLD in lieu of liver biopsy. We conducted this systematic review and meta-analysis to investigate the role of NAFLD fibrosis score (NFS) for prediction of mortality from NAFLD.

Methods: MEDLINE and EMBASE databases were searched through October 2016 for studies that investigated the association between high NFS and mortality. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effects model, generic inverse variance method. The between-study heterogeneity of effect-size was quantified using the Q statistic and I.

Results: A total of five cohort studies with 5033 NAFLD patients were identified. High NFS (score of greater than 0.675) was significantly associated with increased mortality with the pooled RR of 4.54 (95%CI: 1.85-11.17). The statistical heterogeneity was high with I of 88% (P<0.01).

Conclusions: High NFS is associated with increased risk of mortality among patients with NAFLD. This scoring system may be considered as an alternative to liver biopsy for prediction of mortality outcome.