Metabolic Syndrome And Liver-related Events

Background:Liver disease accounts for approximately 2 million deaths per year worldwide,1 million due to complications of cirrhosis and 1 million due to viral hepatitis and hepatocellular carcinoma(HCC).They account for 3.5%of the world’s deaths,an indicator that has been growing steadily from 3%in 2000.At the same time,liver diseases can cause a variety of extrahepatic diseases,which have a significant impact on mortality and quality of life,and cause a further increase in mortality.This indicates that the social pressure and global burden caused by chronic liver disease will also increase.Liver-related events(LREs)are defined as all cirrhosis and its complications,hepatocellular carcinoma and liver-related deaths,in which liver-related deaths refers to deaths caused by liver diseases.Viral hepatitis and excessive alcohol consumption have been identified as major risk factors for chronic liver disease,but the risk factors for about 5% to 30% of chronic liver disease are still unclear.Metabolic syndrome(MetS)refers to the disorder of metabolism ofproteins,fats,carbohydrates and other substances in human body,which results in a series of syndromes in clinical practice.Its components include obesity,abnormal blood sugar,elevated blood pressure,dyslipidemia,protein metabolism disorder,fat metabolism disorder and so on.MetS is a series of risk factors for cardiovascular disease,which has become a global problem.Studies have shown that MetS patients have a higher risk of cardiovascular disease.Recent studies have shown that metabolic syndrome may have some additional correlation with the occurrence of liver disease.Previous studies have shown that there is a correlation between MetS and HCC.MetS promotes the development of HCC.At the same time,some studies have reported the relationship between MetS and cirrhosis and liver-related death.However,there is no relevant research on the overall relationship between MetS and LREs.This study retrospectively analyzed the correlation between MetS and LREs,and determined whether other factors such as positive viral hepatitis in countries or regions would affect the outcome.Methods:Relevant studies were identified from PubMed,EMBASE,and the Cochrane database.Two reviewers independently searched records from January 1980 to December 2017.No language restriction was applied to the search.Then we chose the studies reporting an association betweenMetS and LREs,and used Begg’s and Egger’s tests and visually examined a funnel plot to assess publication bias.All analyses were conducted in Stata14.0 software.Results:There were 19 studies(18 cohort and 1 case-control)included in the analysis,with a total of 1,561,457 participants.The subjects’ ages ranged from 18 to 84 years.The combined analysis showed an overall 86%increase risk of LREs in cases with MetS(RR: 1.86,95% CI: 1.56–2.23).The funnel plot was asymmetrical,and the Egger’s test p values showed a publication bias in this meta analysis.However,through the trim and fill method,we obtained a new RR value for LREs with MetS of 1.49(95% CI:1.40–1.58,p=0.000).There was no obvious difference with the two answers,so we concluded that the results were robust.For hepatitis B positive patients,the RR for MetS and LREs was 2.15(95% CI:1.02–4.53,p=0.038),but for the hepatitis B negative patients,the RR was 1.85(95%CI:1.53–2.24,p=0.000).And for Europeans and Americans,the RR for MetS and LREs was 2.21(95% CI: 1.66–2.69,p=0.000),while for Asians,the RR was 1.73(95% CI: 1.35–2.22,p=0.000).Conclusions:This meta-analysis showed that MetS is associated with a moderately increased risk of LREs prevalence.Patients with MetS together with hepatitis B are more likely to develop hepatic events.For Europeans andAmericans,MetS is more likely to increase the incidence of LREs.