title: Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Liver stiffness measurement (LSM), using elastography, can independently predict outcomes of patients with chronic liver diseases (CLDs). However, there is much variation in reporting and consistency of findings. We performed a systematic review and meta-analysis to evaluate the association between LSM and outcomes of patients with CLDs.
  
  
  METHODS
  We performed a systematic review of the literature, through February 2013, for studies that followed up patients with CLDs prospectively for at least 6 months and reported the association between baseline LSM and subsequent development of decompensated cirrhosis or hepatocellular carcinoma (HCC), as well as mortality. Summary relative risk (RR) estimates per unit of LSM and 95% confidence intervals (CIs) were estimated using the random effects model.
  
  
  RESULTS
  Our final analysis included 17 studies, reporting on 7058 patients with CLDs. Baseline LSM was associated significantly with risk of hepatic decompensation (6 studies; RR, 1.07; 95% CI, 1.03-1.11), HCC (9 studies; RR, 1.11; 95% CI, 1.05-1.18), death (5 studies; RR, 1.22; 95% CI, 1.05-1.43), or a composite of these outcomes (7 studies; RR, 1.32; 95% CI, 1.16-1.51). We observed considerable heterogeneity among studies-primarily in the magnitude of effect, rather than the direction of effect. This heterogeneity could not be explained by variations in study locations, etiologies and stages of CLD, techniques to measure liver stiffness, adjustment for covariates, or method of imputing relationship in the meta-analysis.
  
  
  CONCLUSIONS
  Based on a meta-analysis of cohort studies, the degree of liver stiffness is associated with risk of decompensated cirrhosis, HCC, and death in patients with CLDs. LSM therefore might be used in risk stratification.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: singh.siddharth2@mayo.edu.
authors: Siddharth
authors: S
authors: Singh
authors: Larissa L
authors: LL
authors: Fujii
authors: Mohammad Hassan
authors: MH
authors: Murad
authors: Zhen
authors: Z
authors: Wang
authors: Sumeet K
authors: SK
authors: Asrani
authors: Richard L
authors: RL
authors: Ehman
authors: Patrick S
authors: PS
authors: Kamath
authors: Jayant A
authors: JA
authors: Talwalkar
mesh_terms: D002908:Chronic Disease; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods; D006801:Humans; D008099:Liver / Q000473:pathology*; D017093:Liver Failure / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis
keywords: CI; CLD; Cancer; Cirrhosis; Elastography; HCC; HCV; HR; HVPG; LSM; LT; MELD; MRE; Outcomes; Prognosis; RR; TE; chronic liver disease; confidence interval; hazard ratio; hepatic venous pressure gradient; hepatitis C virus; hepatocellular carcinoma; liver stiffness measurement; liver transplantation; magnetic resonance elastography; model for end-stage liver disease; relative risk; transient elastography
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