Evidence map›Paper›PMID 28130788›Full record

SynthesisHepatology (Baltimore, Md.)2017

Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis.

Parambir S Dulai, Siddharth Singh, Janki Patel, Meera Soni, Larry J Prokop, Zobair Younossi, Giada Sebastiani, Mattias Ekstedt, Hannes Hagstrom, Patrik Nasr and 5 more

2 registry-linked trialsOpen access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Hepatology (Baltimore, Md.), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 929 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
929citing papers in PubMed, 10 pooled it
97.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04475276 phase4completednot on this mapstarted 2021, after this paper: background citation

Effect of Alpha Lipoic Acid on Non-alcoholic Fatty Liver Diseases: A Randomized Placebo-controlled Clinical Trial

TypeinterventionalSponsorAll India Institute of Medical Sciences, BhubaneswarRan2021 to 2024Enrolled120ConditionsNon-Alcoholic Fatty Liver DiseaseArmsPlacebo, Alphalipoic acid
NCT05712603 completednot on this mapstarted 2022, after this paper: background citation

A Care Path for the Detection of Advanced NAFLD-fibrosis: the Nijmegen-Leiden-Amsterdam 2-tiered Care Path Study - the NLA2 Study

TypeobservationalSponsorAcademisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)Ran2022 to 2024Enrolled655ConditionsNon-Alcoholic Fatty Liver DiseaseArmsFIB4-score, Vibration controlled transient elastography, Enhanced Liver Fibrosis test
3 · Its place in the literature

Who cites it

929 citing papers in PubMed, 10 syntheses or guidelines pooled it, 1,846 citations in OpenAlex.

  1. Pooled it
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  8. Accuracy of Non-Invasive Imaging Techniques for the Diagnosis of MASH in Patients With MASLD: A Systematic Review.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Pooled it
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  11. Trial
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  17. Age-Specific Associations of Polygenic Risk Scores With Advanced Fibrosis and Histological Activity in Biopsy-Proven MASLD.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
  18. Article
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869 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 8 institutions in 4 countries.

Parambir S DulaiNAFLD Research Center, University of California at San Diego, La Jolla, CA.
Siddharth SinghNAFLD Research Center, University of California at San Diego, La Jolla, CA.
Janki PatelNAFLD Research Center, University of California at San Diego, La Jolla, CA.
Meera SoniNAFLD Research Center, University of California at San Diego, La Jolla, CA.
Larry J ProkopDepartment of Library Services, Mayo Clinic, Rochester, MN.
Zobair YounossiCenter for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA.
Giada SebastianiDepartment of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Mattias EkstedtDepartment of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
Hannes HagstromDepartment of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Patrik NasrDepartment of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
Per StalDepartment of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Vincent Wai-Sun WongDepartment of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
Stergios KechagiasDepartment of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
Rolf HultcrantzDepartment of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Rohit LoombaNAFLD Research Center, University of California at San Diego, La Jolla, CA.
University of California, San Diego · USLinköping University · SEKarolinska Institutet · SEChinese University of Hong Kong · CNInova Fairfax Hospital · USKarolinska University Hospital · SEMayo Clinic in Arizona · USMcGill University Health Centre · CA

Funding

Yeast Genetics and Stress Response Genes-BiomedicalP42ES010337 · NIEHS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI TUKEY, ROBERT H · 2000 to 2022
$69.8M
Training Grant in GastroenterologyT32DK007202 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI GHOSH, PRADIPTA · 1985 to 2022
$7.7M
QUS Technology for Diagnosis and Grading of Hepatic Steatosis in NAFLDR01DK106419 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI LOOMBA, ROHIT, SIRLIN, CLAUDE B · 2015 to 2019
$3.4M
GENETIC EPIDEMIOLOGY OF NONALCOHOLIC FATTY LIVER DISEASEK23DK090303 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI LOOMBA, ROHIT · 2011 to 2014
$721k
NIDDK NIH HHS K23 DK090303NIDDK NIH HHS R01 DK106419NIDDK NIH HHS T32 DK007202NIEHS NIH HHS P42 ES010337
6 · The paper itself

Abstract

Liver fibrosis is the most important predictor of mortality in nonalcoholic fatty liver disease (NAFLD). Quantitative risk of mortality by fibrosis stage has not been systematically evaluated. We aimed to quantify the fibrosis stage-specific risk of all-cause and liver-related mortality in NAFLD. Through a systematic review and meta-analysis, we identified five adult NAFLD cohort studies reporting fibrosis stage-specific mortality (0-4). Using fibrosis stage 0 as a reference population, fibrosis stage-specific mortality rate ratios (MRRs) with 95% confidence intervals (CIs) for all-cause and liver-related mortality were estimated. The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Included were 1,495 NAFLD patients with 17,452 patient years of follow-up. Compared to NAFLD patients with no fibrosis (stage 0), NAFLD patients with fibrosis were at an increased risk for all-cause mortality, and this risk increased with increases in the stage of fibrosis: stage 1, MRR = 1.58 (95% CI 1.19-2.11); stage 2, MRR = 2.52 (95% CI 1.85-3.42); stage 3, MRR = 3.48 (95% CI 2.51-4.83); and stage 4, MRR = 6.40 (95% CI 4.11-9.95). The results were more pronounced as the risk of liver-related mortality increased exponentially with each increase in the stage of fibrosis: stage 1, MRR = 1.41 (95% CI 0.17-11.95); stage 2, MRR = 9.57 (95% CI 1.67-54.93); stage 3, MRR = 16.69 (95% CI 2.92-95.36); and stage 4, MRR = 42.30 (95% CI 3.51-510.34). Limitations of the study include an inability to adjust for comorbid conditions or demographics known to impact fibrosis progression in NAFLD and the inclusion of patients with simple steatosis and nonalcoholic steatohepatitis without fibrosis in the reference comparison group.

conclusionThe risk of liver-related mortality increases exponentially with increase in fibrosis stage; these data have important implications in assessing the utility of each stage and benefits of regression of fibrosis from one stage to another. (Hepatology 2017;65:1557-1565).

Indexed as

FibrosisHumansLiverNon-alcoholic Fatty Liver Disease

Identifiers

PMID28130788
PMCPMC5397356
OpenAlexW2580009538

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.