The DOI matches its Crossref record; 27 of the 28 references it cites were found in a registry or an index.
Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis
Open accessAbstract
BACKGROUND: Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD. METHODS: This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226. FINDINGS: Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression. INTERPRETATION: Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. FUNDING: Innovative Medicines Initiative 2.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“All these tests were signi fi cant predictors of the primary outcome (overall mortality and liver-related outcomes). 187”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [187]
The cited source says what the claim attributes to it.
In the citing paper
“A recent individual participant data meta-analysis including 2,518 participants, with a median follow-up of 57 months, showed that time-dependent AUCs at 5 years were 0.72 for histology, 0.76 for LSM-VCTE, 0.74 for FIB-4, and 0.70 for NFS.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [187]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Design and validation of a histological scoring system for nonalcoholic fatty liver disease†
Kleiner, D. E., Brunt, E. M., Van Natta, M., Behling, C., Contos, M. J., Cummings, O. W., Ferrell, L. D., Liu, Y., Torbenson, M. S., Unalp‐Arida, A., et al. (2005) · Hepatology · doi:10.1002/hep.20701 · Cited by 10,791
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
Younossi, Z., Anstee, Q. M., Marietti, M., Hardy, T., Henry, L., Eslam, M., George, J., & Bugianesi, E. (2018) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2017.109 · Cited by 5,249
Self-citationAngulo, P., Hui, J. M., Marchesini, G., Bugianesi, E., George, J., Farrell, G. C., Enders, F., Saksena, S., Burt, A. D., Bida, J. P., et al. (2007) · Hepatology · doi:10.1002/hep.21496 · Cited by 3,255
Self-citationEkstedt, M., Hagström, H., Nasr, P., Fredrikson, M., Stål, P., Kechagias, S., & Hultcrantz, R. (2015) · Hepatology · doi:10.1002/hep.27368 · Cited by 2,287
Self-citationBerzigotti, A., Tsochatzis, E., Boursier, J., Castera, L., Cazzagon, N., Friedrich-Rust, M., Petta, S., & Thiele, M. (2021) · Journal of Hepatology · doi:10.1016/j.jhep.2021.05.025 · Cited by 1,925
Self-citationComparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease
Shah, A. G., Lydecker, A. D., Murray, K. F., Tetri, B., Contos, M. J., & Sanyal, A. J. (2009) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2009.05.033 · Cited by 1,561
Hirschfield, G. M., Beuers, U., Corpechot, C., Invernizzi, P., Jones, D., Marzioni, M., & Schramm, C. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2017.03.022 · Cited by 1,480 · cited 1×
“For example, the advent of direct-acting antivirals for hepatitis C means that biopsy is no longer needed before treatment, 28 and improvement in immunoserology 29 means that liver biopsy is not needed in the diagnosis of primary biliary cholangitis.”
EASL recommendations on treatment of hepatitis C: Final update of the series☆
Pawlotsky, J., Negro, F., Aghemo, A., Berenguer, M., Dalgård, O., Dusheiko, G. M., Marra, F., Puoti, M., & Wedemeyer, H. H. (2020) · Journal of Hepatology · doi:10.1016/j.jhep.2020.08.018 · Cited by 1,263
Self-citationProspective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease
Sanyal, A. J., Van Natta, M. L., Clark, J., Neuschwander-Tetri, B. A., Diehl, A., Dasarathy, S., Loomba, R., Chalasani, N., Kowdley, K., Hameed, B., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2029349 · Cited by 1,146
Hagström, H., Nasr, P., Ekstedt, M., Hammar, U., Stål, P., Hultcrantz, R., & Kechagias, S. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2017.07.027 · Cited by 1,067
Self-citation
Cited by
Sorted by citations
Items 201–214 of 214
Upcoming therapies for steatotic liver disease: Translating breakthroughs into clinical practice
Newsome, P. N., & Ajaz, S. (2026) · Journal of Internal Medicine · doi:10.1111/joim.70143 · Cited by 1
Self-citationMoreau, C., Roux, M., Riou, J., Hagström, H., Lin, H., Lee, H. W., Yip, T. C., Tsochatzis, E. A., Petta, S., Bugianesi, E., et al. (2026) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2026.08.032 · Cited by 1
Self-citationNoninvasive surrogate endpoints in MASH trials: current perspectives and challenges
Lee, H. W., Díaz, L. A., Wong, V. W., & Chan, W. (2026) · Hepatology International · doi:10.1007/s12072-026-11148-7
Self-citationGee, M. F. W., Billin, A. N., Chalfin, D. B., Fonstad, R. K., Devol, E. B., Feld, J. J., Patel, K., & Sanyal, A. J. (2026) · JHEP Reports · doi:10.1016/j.jhepr.2026.102041 · Cited by 1
Self-citationKratzer, W., Binzberger, A., Kauschke, S. G., Dolze, F., Werner, M., Barth, T. F. E., Feller, M., Neubauer, H., Simon, E., Brunner, A., et al. (2026) · Ultraschall in der Medizin - European Journal of Ultrasound · doi:10.1055/a-2942-6555
EASL-EASD-EASO guidance on the use of resmetirom and semaglutide as MASH-targeted therapy
Tacke, F., Horn, P., Wong, V. W. S., Ratziu, V., Bugianesi, E., Francque, S., Zelber‐Sagi, S., Caussy, C., Roden, M., Gastaldelli, A., et al. (2026) · Journal of Hepatology · doi:10.1016/j.jhep.2026.08.028
Self-citationJang, S. J., & Shine, B.-K. (2026) · Daehan imsang geon-gang jeungjin hakoeji/Daehan imsang geon'gang jeungjin haghoeji · doi:10.15384/kjhp.2026.00283
Labate, A. M., Villari, P., Cimino, E., Giacomelli, L., Ettori, S., Oladeji, O. A., & Agosti, B. (2026) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2026.105008
Jimson, L., Lavanya, V., Kumar, K. K., Nanthini, S., Shri, S. J., & Ponsneha, G. (2026) · International Conference on Natural Language Processing and Computer Vision (ICNPCV) · doi:10.1109/icnpcv69434.2026.11708810
Wang, L., Ding, L., Ji, G., 高玉杰, Zhang, J., Zhu, C., Wang, W., & Xu, M. (2026) · Research Square · doi:10.21203/rs.3.rs-11193667/v1
Hepatic steatosis in inflammatory bowel disease: practical questions and evidence-based answers
Gisbert, J. P., Lucendo, A. J., & Chaparro, M. (2026) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjag175
From histology to VCTE-based treatment selection in MASLD: Beyond biopsy-selected cohorts
Nakatsuka, T., Kaneko, T., Fujishiro, M., & Tateishi, R. (2026) · JHEP Reports · doi:10.1016/j.jhepr.2026.102079
Liguori, A., & Miele, L. (2026) · Liver International · doi:10.1111/liv.70841
Self-citationVali, Y., Wonders, K., LEE, J., Aithal, G. P., Aller, R., Allison, M., Arola, J. T., Bañales, J. M., Bernal-Monterde, V., Berzigotti, A., et al. (2026) · The Lancet · doi:10.1016/s0140-6736(26)01145-1
Self-citation
Metadata
- Authors
- Mózes, F. E., Lee, J. A., Vali, Y., Alzoubi, O., Staufer, K., Trauner, M., Paternostro, R., Stauber, R. E., Holleboom, A. G., van Dijk, A.-M., Mak, A. L., Boursier, J., de Saint Loup, M., Shima, T., Bugianesi, E., Gaia, S., Armandi, A., Shalimar, Lupșor-Platon, M., Wong, V. W.-S., Li, G., Wong, G. L.-H., Cobbold, J., Karlas, T., Wiegand, J., Sebastiani, G., Tsochatzis, E., Liguori, A., Yoneda, M., Nakajima, A., Hagström, H., Akbari, C., Hirooka, M., Chan, W.-K., Mahadeva, S., Rajaram, R., Zheng, M.-H., George, J., Eslam, M., Petta, S., Pennisi, G., Viganò, M., Ridolfo, S., Aithal, G. P., Palaniyappan, N., Lee, D. H., Ekstedt, M., Nasr, P., Cassinotto, C., de Lédinghen, V., Berzigotti, A., Mendoza, Y. P., Noureddin, M., Truong, E., Fournier-Poizat, C., Geier, A., Martic, M., Tuthill, T., Anstee, Q. M., Harrison, S. A., Bossuyt, P. M., Pavlides, M., Anstee, Q. M., Daly, A. K., Govaere, O., Cockell, S., Tiniakos, D., Bedossa, P., Burt, A., Oakley, F., Cordell, H. J., Day, C. P., Wonders, K., Missier, P., McTeer, M., Vale, L., Oluboyede, Y., Breckons, M., Bossuyt, P. M., Zafarmand, H., Vali, Y., Lee, J., Nieuwdorp, M., Holleboom, A. G., Verheij, J., Ratziu, V., Clément, K., Patino-Navarrete, R., Pais, R., Paradis, V., Schuppan, D., Schattenberg, J. M., Surabattula, R., Myneni, S., Straub, B. K., Vidal-Puig, T., Vacca, M., Rodrigues-Cuenca, S., Allison, M., Kamzolas, I., Petsalaki, E., Campbell, M., Lelliott, C. J., Davies, S., Orešič, M., Hyötyläinen, T., McGlinchey, A., Mato, J. M., Millet, Ó., Dufour, J.-F., Berzigotti, A., Masoodi, M., Pavlides, M., Harrison, S., Neubauer, S., Cobbold, J., Mozes, F., Akhtar, S., Olodo-Atitebi, S., Banerjee, R., Kelly, M., Shumbayawonda, E., Dennis, A., Andersson, A., Wigley, I., Romero-Gómez, M., Gómez-González, E., Ampuero, J., Castell, J., Gallego-Durán, R., Fernández, I., Montero-Vallejo, R., Karsdal, M., Rasmussen, D. G. K., Leeming, D. J., Sinisi, A., Musa, K., Sandt, E., Tonini, M., Bugianesi, E., Rosso, C., Armandi, A., Marra, F., Gastaldelli, A., Svegliati, G., Boursier, J., Francque, S., Vonghia, L., Driessen, A., Ekstedt, M., Kechagias, S., Yki-Järvinen, H., Porthan, K., Arola, J., van Mil, S., Papatheodoridis, G., Cortez-Pinto, H., Rodrigues, C. M. P., Valenti, L., Pelusi, S., Petta, S., Pennisi, G., Miele, L., Geier, A., Trautwein, C., Reißing, J., Aithal, G. P., Francis, S., Palaniyappan, N., Bradley, C., Hockings, P., Schneider, M., Newsome, P., Hübscher, S., Wenn, D., Rosenquist, C., Trylesinski, A., Mayo, R., Alonso, C., Duffin, K., Perfield, J. W., Chen, Y., Yunis, C., Tuthill, T., Harrington, M. A., Miller, M., Chen, Y., McLeod, E. J., Ross, T., Bernardo, B., Schölch, C., Ertle, J., Younes, R., Oldenburger, A., Coxson, H., Ostroff, R., Alexander, L., Biegel, H., Kjær, M. S., Harder, L. M., Davidsen, P., Ellegaard, J., Balp, M.-M., Brass, C., Jennings, L., Martic, M., Löffler, J., Applegate, D., Shankar, S., Torstenson, R., Lindén, D., Fournier-Poizat, C., Llorca, A., Kalutkiewicz, M., Pepin, K., Ehman, R., Horan, G., Ho, G., Tai, D., Chng, E., Patterson, S. D., Billin, A., Doward, L., Twiss, J., Thakker, P., Derdak, Z., Landgren, H., Lackner, C., Gouw, A., & Hytiroglou, P.
- Affiliations
- University of Jordan (JO)
- Medical University of Vienna (AT)
- Medical University of Graz (AT)
- Amsterdam University Medical Centers (NL)
- Chinese University of Hong Kong (HK)
- University Hospital Leipzig (DE)
- Royal Free London NHS Foundation Trust (GB)
- Università Cattolica del Sacro Cuore (IT)
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- McGill University Health Centre (CA)
- University of Malaya (MY)
- First Affiliated Hospital of Wenzhou Medical University (CN)
- The University of Sydney (AU)
- Ehime University (JP)
- University of Milan (IT)
- Gachon University (KR)
- Linköping University (SE)
- Houston Methodist (US)
- Cedars-Sinai Medical Center (US)
- Inserm (FR)
- University of Bern (CH)
- Amsterdam Public Health (NL)
- National Health Service (GB)
- University of Oxford (GB)
- Universitätsklinikum Würzburg (DE)
- University of Turin (IT)
- Centre Hospitalier Universitaire d'Angers (FR)
- University of Nottingham (GB)
- Pfizer (United States) (US)
- Novartis Institutes for BioMedical Research (CH)
- Echosens (France) (FR)
- Corresponding author
- Straub, Beate K
- Ostroff, Rachel
- ORCID
- Alzoubi, Osama
- Staufer, Katharina
- Trauner, Michael
- Paternostro, Rafael
- Stauber, Rudolf E
- Mak, Anne Linde
- Shima, Toshihide
- Gaia, Silvia
- Wong, Vincent Wai-Sun
- Li, Guanlin
- Wong, Grace Lai-Hung
- Karlas, Thomas
- Wiegand, Johannes
- Sebastiani, Giada
- Tsochatzis, Emmanuel
- Liguori, Antonio
- Yoneda, Masato
- Nakajima, Atsushi
- Hagström, Hannes
- Hirooka, Masashi
- Chan, Wah-Kheong
- Mahadeva, Sanjiv
- Rajaram, Ruveena
- Zheng, Ming-Hua
- George, Jacob
- Eslam, Mohammed
- Viganò, Mauro
- Ridolfo, Sofia
- Lee, Dae Ho
- Nasr, Patrik
- Cassinotto, Christophe
- Mendoza, Yuly P
- Noureddin, Mazen
- Truong, Emily
- Daly, Ann K
- Govaere, Olivier
- Cockell, Simon
- Tiniakos, Dina
- Burt, Alastair
- Oakley, Fiona
- Cordell, Heather J
- Day, Christopher P
- Wonders, Kristy
- McTeer, Matthew
- Vale, Luke
- Oluboyede, Yemi
- Nieuwdorp, Max
- Verheij, Joanne
- Ratziu, Vlad
- Clément, Karine
- Pais, Raluca
- Schattenberg, Jörn M
- Surabattula, Rambabu
- Straub, Beate K
- Kamzolas, Ioannis
- Petsalaki, Evangelia
- Lelliott, Chris J
- Davies, Susan
- Orešič, Matej
- Hyötyläinen, Tuulia
- Millet, Óscar
- Dufour, Jean-François
- Masoodi, Mojgan
- Neubauer, Stefan
- Banerjee, Rajarshi
- Kelly, Matt
- Shumbayawonda, Elizabeth
- Dennis, Andrea
- Andersson, Anneli
- Gómez-González, Emilio
- Ampuero, Javier
- Karsdal, Morten
- Rasmussen, Daniel Guldager Kring
- Rosso, Chiara
- Marra, Fabio
- Gastaldelli, Amalia
- Francque, Sven
- Vonghia, Luisa
- Driessen, Ann
- Kechagias, Stergios
- Porthan, Kimmo
- Arola, Johanna
- Papatheodoridis, George
- Valenti, Luca
- Pelusi, Serena
- Miele, Luca
- Trautwein, Christian
- Reißing, Johanna
- Francis, Susan
- Bradley, Christopher
- Hockings, Paul
- Newsome, Philip
- Hübscher, Stefan
- Rosenquist, Christian
- Mayo, Rebeca
- Alonso, Cristina
- Duffin, Kevin
- Perfield, James W
- Chen, Yu
- Yunis, Carla
- Miller, Melissa
- Chen, Yan
- Bernardo, Barbara
- Ertle, Judith
- Younes, Ramy
- Oldenburger, Anouk
- Coxson, Harvey
- Ostroff, Rachel
- Alexander, Leigh
- Biegel, Hannah
- Kjær, Mette Skalshøi
- Harder, Lea Mørch
- Davidsen, Peter
- Balp, Maria-Magdalena
- Jennings, Lori
- Löffler, Jürgen
- Shankar, Sudha
- Lindén, Daniel
- Pepin, Kay
- Ehman, Richard
- Ho, Gideon
- Tai, Dean
- Chng, Elaine
- Patterson, Scott D
- Billin, Andrew
- Doward, Lynda
- Thakker, Paresh
- Lackner, Carolin
- Gouw, Annette
- Hytiroglou, Prodromos
- Venue
- The Lancet Gastroenterology & Hepatology
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 8
- Issue
- 8
- Pages
- 704-713
- ISSN
- 2468-1156 (ISSN-L)
- 2468-1253
- OpenAlex
- W4379467566
- Cited by
- 214
- References
- 28
- Citations by year
- 2026: 52 · 2025: 62 · 2024: 78 · 2023: 22
- FWCI
- 8.33
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet. Gastroenterology & hepatology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- HAL (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Lirias (submittedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by-nc-nd)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
- Utrecht University Repository (Utrecht University) (submittedVersion, cc-by)
- Funders
- Royal Society (221805/Z/20/Z)
- Wellcome Trust
- Ministry of Health and Welfare
- European Federation of Pharmaceutical Industries and Associations
- Korea Health Industry Development Institute (HI14C1135)
- IMI
- Innovative Medicines Initiative (777377)
- Fonds de Recherche du Québec - Santé (296306)
- NIHR Newcastle Biomedical Research Centre
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, liver fibrosis, noninvasive fibrosis assessment, vibration-controlled transient elastography, liver stiffness, FIB-4, NAFLD fibrosis score, liver histopathology, prognostic performance, all-cause mortality, hepatocellular carcinoma, liver cirrhosis, liver transplantation, cirrhosis complications, MELD score, surrogate endpoints
- MeSH terms
- Diabetes Mellitus, Type 2, Esophageal and Gastric Varices, Female, Fibrosis, Gastrointestinal Hemorrhage, Humans, Liver Cirrhosis, Male, Middle Aged, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
