Impact of non-alcoholic fatty liver disease and liver fibrosis on outcomes of acute ischemic stroke: A systematic review and meta-analysis

Objective: We reviewed the evidence on the impact of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis on mortality, functional dependence, and recurrence after acute ischemic stroke (AIS). Methods: This PROSPERO registered review searched PubMed, Embase, CENTRAL, and Web of Science databases from inception of databases to 30th July 2023 for studies comparing outcomes of AIS based on the presence of NAFLD and liver fibrosis. Adjusted data on mortality, functional dependence and risk of recurrent AIS was pooled to obtain odds ratio (OR) with 95% confidence intervals (CI) in a random-effects model Results: Ten studies were included. Descriptive analysis showed conflicting effects of NAFLD on AIS outcomes with some studies showing better functional outcomes with the presence of NAFLD. Meta-analysis showed that the presence of liver fibrosis was associated with a significantly increased risk of mortality (OR: 2.22 95% CI: 1.02–4.86 I2=92%) and functional dependence (OR: 1.89 95% CI: 1.27–2.82 I2=53%) as compared to no fibrosis. Meta-analysis found that liver fibrosis did not increase the risk of recurrent AIS (OR: 1.32 95% CI: 0.74–2.37 I2=74%). Conclusion: Scant evidence exists for the effect of NAFLD and liver fibrosis on AIS outcomes. A paradoxical effect of NAFLD on functional outcomes has been noted which needs confirmation by future studies. Liver fibrosis was found to increase the risk of mortality and functional dependence in AIS. doi: https://doi.org/10.12669/pjms.41.2.10729 How to cite this: Yang L, Han J, Qin C, Song F. Impact of non-alcoholic fatty liver disease and liver fibrosis on outcomes of acute ischemic stroke: A systematic review and meta-analysis. Pak J Med Sci. 2025;41(2):630-636. doi: https://doi.org/10.12669/pjms.41.2.10729 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.