荟萃分析：代谢功能障碍相关脂肪性肝病中肝硬化的全球患病率和死亡率

Meta-Analysis: Global Prevalence and Mortality of Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease.

作者信息

Owrangi Soroor, Paik James M, Golabi Pegah, de Avila Leyla, Hashida Ryuki, Nader Ariana, Paik Annette, Henry Linda, Younossi Zobair M

机构信息

Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.

The Global NASH Council, Washington, DC, USA.

出版信息

Aliment Pharmacol Ther. 2025 Feb;61(3):433-443. doi: 10.1111/apt.18451. Epub 2024 Dec 19.

DOI:10.1111/apt.18451

PMID:39697043

Abstract

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) is responsible for a significant global health burden. Despite this burden, the prevalence and mortality of MASLD-related cirrhosis remain inadequately defined, hindering effective public health strategies. This study aimed to estimate the global prevalence and mortality associated with MASLD-related cirrhosis.

METHODS

A systematic search of PubMed, Ovid MEDLINE, EMBASE, Web of Science and SCOPUS was conducted using keywords related to MASLD and cirrhosis from inception of each database used through June 2024. COVIDENCE was used for abstract and manuscript review. MASLD populations were categorised into 'general practice setting' and 'high risk setting', which indicated studies from inpatient setting or those referred for liver biopsy for an indication (elevated liver enzymes). Our data extraction and quality assessment followed PRISMA guidelines. A random-effects model was utilised for meta-analysis.

RESULTS

From 7924 identified articles, 35 studies comprising 513,742 patients with MASLD met the inclusion criteria. The pooled global prevalence of cirrhosis among MASLD patients was 3.26% (95% CI: 2.47%-4.31%) in general practice settings (4 studies) and 14.51% (95% CI: 11.22%-18.57%) among those in inpatient settings or referred for liver biopsy (31 studies). Regionally, higher prevalence rates in high-risk settings were observed in North America and Australia (18.38%; 95% CI: 9.06%-33.75%), followed by Europe (10.16%; 95% CI: 5.71%-17.44%) and Asia (9.12%; 95% CI: 6.11%-13.40%) (p = 0.007). Notably, ICD-based diagnoses indicated a significantly higher prevalence of cirrhosis (27.43%) compared to those diagnosed by liver biopsy (13.24%; p < 0.001). The pooled all-cause mortality rate for MASLD-cirrhosis patients was estimated at 7.91 per 100 person-years (95% CI: 4.44-13.71) (9 studies).

CONCLUSIONS

This meta-analysis underscores the substantial prevalence of cirrhosis among MASLD patients and highlights significant geographic and demographic variability, calling for improved screening and management strategies.

摘要

背景与目的

代谢功能障碍相关脂肪性肝病（MASLD）给全球带来了沉重的健康负担。尽管负担沉重，但MASLD相关肝硬化的患病率和死亡率仍未得到充分界定，这阻碍了有效的公共卫生策略。本研究旨在估计与MASLD相关肝硬化的全球患病率和死亡率。

方法

使用与MASLD和肝硬化相关的关键词，对PubMed、Ovid MEDLINE、EMBASE、Web of Science和SCOPUS从各数据库创建至2024年6月进行系统检索。使用COVIDENCE进行摘要和稿件评审。MASLD人群分为“普通医疗环境”和“高风险环境”，“高风险环境”指住院环境或因肝脏酶升高而转诊进行肝活检的研究。我们的数据提取和质量评估遵循PRISMA指南。采用随机效应模型进行荟萃分析。

结果

从7924篇已识别文章中，35项研究（共513742例MASLD患者）符合纳入标准。在普通医疗环境中（4项研究），MASLD患者中肝硬化的合并全球患病率为3.26%（95%CI：2.47%-4.31%），在住院环境或转诊进行肝活检的患者中（31项研究）为14.51%（95%CI：11.22%-18.57%）。在各地区，北美和澳大利亚的高风险环境中患病率较高（18.38%；95%CI：9.06%-33.75%），其次是欧洲（10.16%；95%CI：5.71%-17.44%）和亚洲（9.12%；95%CI：6.11%-13.40%）（p = 0.007）。值得注意的是，基于国际疾病分类（ICD）的诊断显示肝硬化患病率（27.43%）显著高于肝活检诊断的患病率（13.24%；p < 0.001）。MASLD肝硬化患者的合并全因死亡率估计为每100人年7.91例（95%CI：4.44-13.71）（9项研究）。