Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A systematic review and meta‐analysis

Abstract Background In patients with nonalcoholic fatty liver disease, liver fibrosis was associated with a higher risk of cardiovascular events. However, the relationship between liver fibrosis scores and clinical outcomes in patients with cardiovascular disease remains unclear. Methods Searching from PubMed, EMBASE and Cochrane Library databases yielded cohort studies that reported adjusted effect size between liver fibrosis scores (Fibrosis‐4 score [FIB‐4] or NAFLD fibrosis score [NFS]) and prognosis in patients with cardiovascular disease. The effect size was computed using a random‐effects model. Results This meta‐analysis included twelve cohort studies involving 25,252 patients with cardiovascular disease. Participants with the highest baseline level of FIB‐4 or NFS had a significantly increased risk of cardiovascular events (FIB‐4, HR: 1.75, 95% CI: 1.53–2.00, I 2 = 0%; NFS, HR: 1.92, 95% CI: 1.50–2.47, I 2 = 47%). This finding was consistent with the analysis of FIB‐4 or NFS as a continuous variable (per 1‐unit increment FIB‐4, HR: 1.15, 95% CI: 1.06–1.24, I 2 = 72%; NFS, HR: 1.15, 95% CI: 1.07–1.24, I 2 = 71%). Furthermore, participants with the highest levels of FIB‐4 or NFS had a greater risk of cardiovascular mortality (FIB‐4, HR: 2.07, 95% CI: 1.19–3.61, I 2 = 89%; NFS, HR: 3.72, 95% CI: 2.62–5.29, I 2 = 60%) and all‐cause mortality (FIB‐4, HR: 1.81, 95% CI: 1.24–2.66, I 2 = 90%; NFS, HR: 3.49, 95% CI: 2.82–4.31, I 2 = 25%). This result was also consistent as a continuous variable. Conclusion Higher levels of FIB‐4 and NFS are related to an increased risk of cardiovascular events, cardiovascular mortality and all‐cause mortality in patients with cardiovascular disease.