Department of Gastroenterology, The Fifth People's Hospital of Chengdu, Chengdu, 611130, China.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
Sci Rep. 2019 Jul 31;9(1):11124. doi: 10.1038/s41598-019-47687-3.
Whether nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of mortality remains controversial. The present study aimed to clarify this issue. A systematic search of PubMed and Embase was conducted through October 2018. Studies providing risk estimates of NAFLD and mortality were included. A random-effects model was employed to calculate summary risk estimates. Subgroup analyses were performed to identify potential effect modifiers. Fourteen studies, involving 498501 subjects and 24234 deaths, were included. Patients with NAFLD were found to be at an elevated risk of all-cause mortality compared with those without [hazard ratio (HR) = 1.34; 95% confidence interval (CI) 1.17-1.54)]. The significantly positive association between NAFLD and all-cause mortality could not be modified by age, sex, follow-up duration, and adjustment for body mass index, diabetes, smoking or hypertension (all P > 0.05), and remained in sensitivity analyses. No significant associations of NAFLD with CVD (HR = 1.13; 95% CI 0.92-1.38) and cancer (HR = 1.05; 95% CI 0.89-1.25) mortality were found. In conclusion, NAFLD is a predictor of increased all-cause mortality but not CVD and cancer mortality. These findings have important implications for decision making in public health and clinical practice, and highlight the urgency of developing effective treatments for NAFLD.
非酒精性脂肪性肝病（NAFLD）是否与死亡率增加相关仍存在争议。本研究旨在阐明这一问题。通过 2018 年 10 月对 PubMed 和 Embase 进行了系统检索。纳入了提供 NAFLD 和死亡率风险估计的研究。采用随机效应模型计算汇总风险估计。进行了亚组分析以确定潜在的效应修饰剂。共纳入 14 项研究，涉及 498501 例患者和 24234 例死亡。与无 NAFLD 的患者相比，NAFLD 患者的全因死亡率更高[风险比（HR）=1.34；95%置信区间（CI）1.17-1.54]。NAFLD 与全因死亡率之间的显著正相关关系不能通过年龄、性别、随访时间以及对体重指数、糖尿病、吸烟或高血压的调整来改变（均 P>0.05），并且在敏感性分析中仍然存在。NAFLD 与心血管疾病（CVD）（HR=1.13；95%CI 0.92-1.38）和癌症（HR=1.05；95%CI 0.89-1.25）死亡率之间无显著关联。总之，NAFLD 是全因死亡率增加的预测指标，但不是 CVD 和癌症死亡率的预测指标。这些发现对公共卫生和临床实践中的决策具有重要意义，并强调了开发 NAFLD 有效治疗方法的紧迫性。
