Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis

Kim, Hee Yeon; Yu, Jung Hwan; Chon, Young Eun; Kim, Seung Up; Kim, Mi Na; Han, Ji Won; Lee, Han Ah; Jin, Young-Joo; An, Jihyun; Choi, Miyoung; Jun, Dae Won

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Original Article

Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis

Hee Yeon Kim¹, Jung Hwan Yu², Young Eun Chon³, Seung Up Kim^4,5, Mi Na Kim^4,5, Ji Won Han⁶, Han Ah Lee⁷, Young-Joo Jin², Jihyun An⁸, Miyoung Choi⁹, Dae Won Jun¹⁰

¹Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
²Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
³Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
⁴Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
⁵Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
⁶Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
⁷Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
⁸Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
⁹Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Republic of Korea
¹⁰Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea

Correspondence :

Miyoung Choi ,
Tel: +82-2-2174-2848, Fax: +82-2-747-4918, Email: mychoi@neca.re.kr
Dae Won Jun ,
Tel: +82-2-2220-8338, Fax: +82-2-2298-9183, Email: noshin@hanyang.ac.kr

Received: May 13, 2024 Revised: July 12, 2024 Accepted: July 28, 2024
*Hee Yeon Kim and Jung Hwan Yu contributed equally to this work.

ABSTRACT

Background/Aims
Although important, clinically significant liver fibrosis is often overlooked in the general population. We aimed to examine the prevalence of clinically significant liver fibrosis using noninvasive tests (NITs) in the general population.
Methods
We collected data from four databases (MEDLINE, Embase, Cochrane Library, and KoreaMed) from inception to June 13, 2023. Original articles reporting the prevalence of clinically significant liver fibrosis in the general population were included. The Stata metaprop function was used to obtain the pooled prevalence of liver fibrosis with NITs in the general population.
Results
We screened 6,429 articles and included 45 eligible studies that reported the prevalence of clinically significant liver fibrosis in the general population. The prevalence of advanced liver fibrosis, using the high probability cutoff of the fibrosis-4 (FIB-4) index, was 2.3% (95% confidence interval [CI], 1.2–3.7%). The prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, assessed using vibration-controlled transient elastography (VCTE) among the general population, was 7.3% (95% CI, 5.9–8.8%), 3.5% (95% CI, 2.7–4.5), and 1.2% (95% CI, 0.8–1.8%), respectively. Region-based subgroup analysis revealed that the highest prevalence of advanced fibrosis using the high probability cutoff of the FIB-4 index was observed in the American region. Furthermore, the American region exhibits the highest prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, using VCTE.
Conclusions
Previously undiagnosed clinically significant liver fibrosis is found in the general population through NITs. Future research is necessary to stratify the risk in the general population.

KeyWords: general population; liver fibrosis; noninvasive test; meta-analysis; systematic review