ArticleBMC medicine2019
Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts.
Article in BMC medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06802731 (A Multicenter Study on the Application of LivQ-box® Parameters in the Diagnosis of Liver Inflammation in Patients with Non-alcoholic Fatty Liver Disease), which is not on this map. Cited by 171 papers, 9 of them syntheses that pooled it.
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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.
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.
A Multicenter Study on the Application of LivQ-box® Parameters in the Diagnosis of Liver Inflammation in Patients with Non-alcoholic Fatty Liver Disease
Who cites it
171 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Prevention, surveillance, and early detection of hepatocellular carcinoma - a Brazilian multidisciplinary consensus.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2026Guideline
- Epidemiology of Metabolic Dysfunction-Associated Steatotic Liver Disease in South Asian Ethnicities: A Systematic Review and Meta-Analysis.Journal of gastroenterology and hepatology · 2025Pooled it
- The Green Path to Liver Health: Herbal Solutions for Non-alcoholic Steatohepatitis.Cardiovascular & hematological disorders drug targets · 2025Pooled it
- EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).Obesity facts · 2024Guideline
- Risk factors of hepatocellular carcinoma associated with nonalcoholic fatty liver disease: Systematic review and meta-analysis.Technology and health care : official journal of the European Society for Engineering and Medicine · 2024Pooled it
- Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk.International journal of molecular sciences · 2023Pooled it
- AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review.Gastroenterology · 2022Guideline
- [Guideline for stratified screening and surveillance of primary liver cancer(2020 Edition)].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2021Guideline
- Pooled it
- Combination of tofogliflozin and pioglitazone for NAFLD: Extension to the ToPiND randomized controlled trial.Hepatology communications · 2022Trial
- Steatotic Liver Disease Risk Scores to Predict Cirrhosis and Hepatocellular Carcinoma.JAMA internal medicine · 2026Article
- The Emerging Challenge of Non-Cirrhotic MASLD-Related Hepatocellular Carcinoma: Etiology, Immunopathology, and Precision Oncology.Liver cancer · 2026Review
- Genetically Determined Loss-of-Function of the Organic Cation Transporter OCT1 Is Associated with Lower Liver Fat Content in Humans.International journal of molecular sciences · 2026Article
- Longitudinal changes in cardiometabolic risk factors are associated with changes in liver stiffness in adults with MASLD.Journal of hepatology · 2026Article
- Association between high-risk metabolic dysfunction-associated steatohepatitis and ischemic heart disease: a nationally representative study.Nutrition journal · 2026Article
- Hepatoprotection of Jianpi Qingre Lishi prescription on non-alcoholic steatohepatitis miRNA-27/peroxisome proliferator-activated receptor gamma axis.Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan · 2026Article
- Effect of coded steatotic liver disease on outcomes of percutaneous coronary intervention in non-diabetic adults: insights from a multicenter real-world cohort.BMC cardiovascular disorders · 2026Observational
- Article
- Ligature-induced periodontitis exacerbates high-carbohydrate/high-fat diet-induced fatty liver in mice under non-diabetic conditions.BMC oral health · 2026Article
- Real-world evidence in metabolic dysfunction-associated steatotic liver disease (MASLD): insights, challenges, and future directions.The Lancet regional health. Europe · 2026Review
111 more citing papers are in PubMed but not listed here.
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Authors and funding
14 authors.
Funding
Abstract
backgroundNon-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). Here we used healthcare records of 18 million adults to estimate risk of acquiring advanced liver disease diagnoses in patients with NAFLD or NASH compared to individually matched controls.
methodsData were extracted from four European primary care databases representing the UK, Netherlands, Italy and Spain. Patients with a recorded diagnosis of NAFLD or NASH (NAFLD/NASH) were followed up for incident cirrhosis and HCC diagnoses. Each coded NAFLD/NASH patient was matched to up to 100 "non-NAFLD" patients by practice site, gender, age ± 5 years and visit recorded within ± 6 months. Hazard ratios (HR) were estimated using Cox models adjusted for age and smoking status and pooled across databases by random effects meta-analyses.
resultsOut of 18,782,281 adults, we identified 136,703 patients with coded NAFLD/NASH. Coded NAFLD/NASH patients were more likely to have diabetes, hypertension and obesity than matched controls. HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43-9.19) and for HCC, 3.51 (95% CI 1.72-7.16). HR for either outcome was higher in patients with NASH and those with high-risk Fib-4 scores. The strongest independent predictor of a diagnosis of HCC or cirrhosis was baseline diagnosis of diabetes.
conclusionsReal-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasising the need to identify specific groups of patients at highest risk.
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