Letter regarding “Prevalence of clinically significant liver fibrosis in the general population”
Article information
Dear Editor,
Chronic liver disease has become a major public health problem worldwide, caused mainly by multiple factors such as viral hepatitis, excessive alcohol consumption and metabolic disorders, and is often associated with chronic inflammation that can progress to fibrosis, cirrhosis and even liver cancer without timely intervention. Since most patients with chronic liver disease do not have obvious symptoms until they develop symptoms of decompensation, research is urgently needed to develop early screening and intervention methods to stop the progression of liver fibrosis to more severe stages. We read with great interest a recent study by Kim et al. published in Clin Mol Hepatol [1]. The major contribution of this study is that it expands the knowledge of the prevalence of liver fibrosis in asymptomatic populations and provides a basis for the development of screening strategies and public health interventions. However, there are several points in this article that need to be clarified.
First, the authors emphasized in their article that a comprehensive search of four databases, EMBASE, MEDLINE, Cochrane Library, and KoreaMed, was performed. However, we found that four eligible studies were not included [2-5]. Therefore, it is recommended to extend the search to the following commonly used English databases, including Google Scholar, Web of Science, Scopus, and PsycINFO, to avoid possible omissions. Second, the screening criteria in this paper are flawed. For example, what are the specific noninvasive tests? Should patients with comorbid severe obesity or cardiovascular disease be included? In addition, given that studies with too small a sample size carry a large confounding bias, we suggest that the authors should have included only studies with sample sizes greater than 100. Third, there was substantial heterogeneity in the pooled results for the prevalence of liver fibrosis, but the sources of heterogeneity were not effectively assessed in the text. We suggest that meta-regression analyses be performed to assess the potential association of demographic covariates (e.g., age, sex, comorbidities, alcohol consumption, lipid profile, etc.) with study outcomes. Finally, in the discussion of the article, the authors mention that “risk factors independently associated with advanced liver fibrosis include obesity, diabetes mellitus, metabolic syn-drome, excessive alcohol consumption, fatty liver, elevated liver enzymes, and advanced age”. However, we found that a significant proportion of the included studies reported information on the association of various covariates with the risk of advanced fibrosis. Therefore, we suggest that the authors could have reported the pooled odds ratio of potential risk factors for advanced liver fibrosis and cirrhosis in the general population to quantify possible risk factors.
Notes
Authors’ contribution
Wei Feng wrote the manuscript and provided financial support, Qile Wang provided methodological and theoretical support, and Qingwang Ye revised the manuscript.
Conflicts of Interest
The authors have no conflicts to disclose.
Acknowledgements
Suqian Sci&Tech Program Grant (No. S202317); Scientific research project of Health Commission of Jiangsu P.R. (No. Z2023017).