Hepatology International

, Volume 13, Issue 5, pp 560–572 | Cite as

The prognostic role of liver stiffness in patients with chronic liver disease: a systematic review and dose–response meta-analysis

  • Yue Shen
  • Sheng-Di Wu
  • Ling Wu
  • Si-Qi Wang
  • Yao Chen
  • Li-Li Liu
  • Jing Li
  • Chang-Qing Yang
  • Ji-Yao Wang
  • Wei JiangEmail author
Original Article


Background and aims

Liver stiffness measurement (LSM) by transient elastography (TE) has been assessed for the evaluation of clinically relevant outcomes in patients with chronic liver diseases (CLDs) while with variable results. This systematic review and meta–analysis aims to investigate the relationship between baseline LSM by TE and the development of clinically relevant outcomes.


The systematic review identified eligible cohorts reporting the association between baseline LSM by TE and risk of hepatic carcinoma (HCC), hepatic decompensation (HD), all–cause and/or liver–related mortality and liver–related events (LREs) in CLD patients. Summary relative risks (RRs) with 95% confidence intervals (CIs) were estimated using a random–effect model. The dose–response association was evaluated by generalized least squares trend (Glst) estimation and restricted cubic splines. Commands of GLST, MKSPLINE, MVMETA were applied for statistical analysis.


62 cohort studies were finally included, reporting on 43,817 participants. For one kPa (kilopascal) increment in baseline liver stiffness (LS), the pooled RR (95% CI) was 1.08 (1.05–1.11) for HCC, 1.08 (1.06–1.11) for all–cause mortality, 1.11 (1.05–1.17) for liver-related mortality, 1.08 (1.06–1.10) for HD and 1.07 (1.04–1.09) for LREs. Furthermore, the nonlinear dose–response analysis indicated that the significant increase in the risk of corresponding clinically relevant outcomes turned to a stable increase or a slight decrease with increasing baseline LS changing primarily in the magnitude of effect rather than the direction.


The dose–response meta-analysis presents a combination between the levels of baseline LS and RRs for each clinically relevant outcome. TE, which is noninvasive, might be a novel strategy for risk stratification and identification of patients at high risk of developing these outcomes.


Fibroscan Liver Cancer Cirrhosis Outcome 



Alanine aminotransferase


Chronic hepatitis B


Confidence intervals


Chronic liver disease


Generalized least-squares trend


Hepatitis B virus


Hepatic carcinoma


Hepatitis C virus


Hepatic decompensation


Human immunodeficiency virus


Hazard ratio




Liver-related events


Live stiffness


Liver stiffness measurement


Portal hypertension


Relative risks


Transient elastography


Upper limit of normal



The study was supported by the National Nature Science Foundation, No. 81670541; and National Science and Technology Major Project of China, No. 2013ZX10002004 and No. 2017ZX10203202.

Compliance with ethical standards

Conflict of interest

Yue Shen, Sheng-Di Wu, Ling Wu, Si-Qi Wang, Yao Chen, Li–Li Liu, Jing Li, Chang-Qing Yang, Ji-Yao Wang, Wei Jiang declare that they have no conflict of interest.

Supplementary material

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Supplementary Table 12 (DOC 131 kb)


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Copyright information

© Asian Pacific Association for the Study of the Liver 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyZhongshan Hospital, Fudan UniversityShanghaiPeople’s Republic of China
  2. 2.Department of Emergency Medicine, Zhongshan HospitalFudan UniversityShanghaiPeople’s Republic of China
  3. 3.Department of Gastroenterology, Tongji HospitalTongji UniversityShanghaiPeople’s Republic of China

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