Early mortality following COVID-19 infection among cancer patients who received radiotherapy: A meta-analysis

Abstract Introduction: Identifying the patients at higher risk for poor outcomes after radiotherapy (RT) during COVID-19 era is an unmet clinical need. Methods: The Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed, and Wiley-Blackwell Cochrane Library databases were searched. Eligible studies were required to address the outcomes of cancer patients who underwent RT during the COVID-19 era. The primary outcome was early mortality, while secondary outcomes included length of hospital stay, hospital admission, intensive care unit (ICU) admission, and use of mechanical ventilation. Pooled event rates were calculated and meta-regression and “leave-one-out” sensitivity analyses were performed. Results: Twelve eligible studies were included out of 928. The prevalence of early mortality after COVID-19 infection was 21.0%. The prevalence of hospital admission, ICU admission, and mechanical ventilation was 78.1%, 15.4%, and 20.0%, respectively. Meta-regression showed that older age was significantly and positively associated with early mortality (β=0.0765 ± 0.0349, p = 0.0284), while breast cancer was negatively associated with early mortality (β=-1.2754 ± 0.6373, p = 0.0454). Conclusion: Older age adversely impacts the early mortality rate in cancer patients during COVID-19 era. The risks of interruption/delay of cancer treatment should be weighed against the risk of increased morbidity and mortality from the infection. A global registry is needed to establish international oncologic guidelines during the COVID-19 era.

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Age and the Length of Hospital Stay in Patients With Sepsis at the ICU Admission can Prolong the Duration of Endotracheal Intubation

Hospital Practices and Research ◽

10.34172/hpr.2021.12 ◽

2021 ◽

Vol 6 (2) ◽

pp. 65-70

Author(s):

Farshid Rahimibashar ◽

Amir Vahedian-Azimi ◽

Mahmood Salesi ◽

Masoum Khosh Fetrat

Keyword(s):

Mechanical Ventilation ◽

Hospital Stay ◽

Endotracheal Intubation ◽

Prolonged Mechanical Ventilation ◽

Length Of Hospital Stay ◽

Older Age ◽

Icu Admission ◽

Survival Difference ◽

Significant Survival ◽

The Impact

Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critically ill patients admitted to intensive care unit (ICU) with sepsis. Objectives: This study aimed to assess the impact of important factors on the duration of tracheal intubation in patients with sepsis at the ICU admission. Methods: Adult patients admitted to the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ventilation (PMV) (≥ 21 days) were included in this retrospective secondary analysis study. The primary outcome was ICU mortality. Baseline demographic and clinical characteristics of all patients were assessed as risk factors associated with the duration of MV by univariate and multivariate Binary logistic regression. Results: Eighty-five patients required more than 21 days of MV. Out of the 85 patients, 52 (61.2%) patients were intubated within 30 to 34.50 days and 33 (38.8%) patients had intubation within 34.51 to 65 days, and categorized as PMV and very prolonged MV groups, respectively. Two parameters were significantly associated with very prolonged MV which are as follows: older age 1.229 (95% CI: 1.002-1.507, P=0.048) and long hospital stay (LOS) 2.996 (95% CI: 1.676-5.356, P<0.001). No significant survival difference was observed between the two groups of study. (33.3% vs. 25%, P=0.406). Conclusion: Our observations showed that the older age and LOS as pre-ICU stay in patients with positive sepsis at the ICU admission can prolong the duration of intubation. In addition, no significant survival difference was observed between patients with PMV and very prolonged MV.

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Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽

10.1136/bmjopen-2020-044384 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044384

Author(s):

Guduru Gopal Rao ◽

Alexander Allen ◽

Padmasayee Papineni ◽

Liyang Wang ◽

Charlotte Anderson ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Outcomes ◽

Severe Infection ◽

Older Age ◽

Cross Sectional ◽

North West ◽

Icu Admission ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

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Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18816 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18816-e18816

Author(s):

Cesar Simbaqueba ◽

Omar Mamlouk ◽

Kodwo Dickson ◽

Josiah Halm ◽

Sreedhar Mandayam ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cancer Patients ◽

Clinical Outcomes ◽

Kidney Injury ◽

Hazard Model ◽

Cancer Center ◽

Icu Admission ◽

Significant Difference ◽

History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

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Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.06.602 ◽

2016 ◽

Vol 62 (6) ◽

pp. 602-609 ◽

Cited By ~ 10

Author(s):

Emiliana Motta ◽

Michele Luglio ◽

Artur Figueiredo Delgado ◽

Werther Brunow de Carvalho

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Randomized Clinical Trials ◽

Length Of Hospital Stay ◽

Pediatric Intensive Care ◽

Essential Elements ◽

Cochrane Library ◽

Abstinence Syndrome

Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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357. A Comparison of Chest CT Findings in Cancer and Non-Cancer Patients with COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.558 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S282-S282

Author(s):

Alexandre Malek ◽

Hiba Dagher ◽

Ray Y Hachem ◽

Ying Jiang ◽

Anne-Marie Chaftari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Admission ◽

Ct Scan ◽

Cancer Patients ◽

Clinical Outcomes ◽

Chest Ct ◽

Non Invasive ◽

Radiologic Findings ◽

Cancer Group ◽

Underlying Diseases

Abstract Background The purpose of this study was to compare chest computed tomography (CT) scan findings in cancer versus non-cancer patients with COVID-19 infection. We sought to assess the correlation between radiologic patterns of COVID-19 pneumonia, clinical course, and outcomes. Methods We performed a retrospective study of COVID-19 positive cancer and non-cancer pts who had chest CT scans at the time of diagnosis, at our hospital and 16 other centers in Asia, Australia, Europe, North America and South America, between March, 2020 and November, 2020. Patients’ age, underlying diseases, symptoms, laboratory studies, and radiologic findings consisting of bilateral ground-glass opacities (GGOs), multifocal organizing pneumonia (MOP) were collected in association with clinical outcomes. Results We identified 426 pts with cancer and 622 non-cancer pts. Thereafter, cancer pts were analyzed into 3 distinct groups and similar to non-cancer pts: GGOs group (n=224, 54%), GGOs+MOP group (n=61, 14.6%), and a third group of neither GGOs or MOP (n=131, 31.4%) in cancer pts, and in non-cancer pts: GGOs group (n=387, 62.8%), GGOs +MOP group (n=100, 16.2%), and a third group of neither GGOs or MOP (n=129, 21%). The median patients’ age was 54 in non-cancer pts vs 62 in cancer pts (p< 0.001) and there were more males in the non-cancer group 57% vs 47% (p=0.001). Cough was more prevalent in non-cancer pts, 71% vs 59% (p< 0.001) and similar to fever (73% vs 57%, p< 0.001). Neutropenia < 0.5 k/µL and lymphocytopenia < 1 k/µL were more frequent in cancer pts (p< 0.001). In cancer pts, there was no statistically significance difference between the 3 groups (hospital admission, mechanical ventilation, readmission within 30 days, and mortality), except pts who required non-invasive (NI) ventilation were more frequent in the GGOs group, 55% (p=0.005). In non-cancer, pts with GGOs +MOP have higher hospital admission, ICU transfer, NI- and mechanical ventilation compared to the 2 other groups (p< 0.001). While readmission to hospital or mortality rate within 30 days were similar between the 3 groups. Conclusion This study reveals that non-cancer pts tended to have more radiologic findings on chest CT scan compared to cancer pts at the time of COVID-19 diagnosis and were associated with more worrisome COVID-19-related clinical outcomes. Disclosures All Authors: No reported disclosures

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Obesity is associated with severe disease and mortality in patients with coronavirus disease 2019 (COVID-19): a meta-analysis

BMC Public Health ◽

10.1186/s12889-021-11546-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zixin Cai ◽

Yan Yang ◽

Jingjing Zhang

Keyword(s):

Mechanical Ventilation ◽

Fixed Effects ◽

Web Of Science ◽

Meta Analysis ◽

Severe Disease ◽

Cochrane Library ◽

Risk Of Infection ◽

Icu Admission ◽

Increased Risk ◽

Nonobese Patients

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to global research to predict those who are at greatest risk of developing severe disease and mortality. The aim of this meta-analysis was to determine the associations between obesity and the severity of and mortality due to COVID-19. Methods We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies evaluating the associations of obesity with COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. Meta-regression analyses were conducted to estimate regression coefficients. Results Forty-six studies involving 625,153 patients were included. Compared with nonobese patients, obese patients had a significantly increased risk of infection. (OR 2.73, 95% CI 1.53–4.87; I2 = 96.8%), hospitalization (OR 1.72, 95% CI 1.55–1.92; I2 = 47.4%), clinically severe disease (OR 3.81, 95% CI 1.97–7.35; I2 = 57.4%), mechanical ventilation (OR 1.66, 95% CI 1.42–1.94; I2 = 41.3%), intensive care unit (ICU) admission (OR 2.25, 95% CI 1.55–3.27; I2 = 71.5%), and mortality (OR 1.61, 95% CI 1.29–2.01; I2 = 83.1%). Conclusion Patients with obesity may have a greater risk of infection, hospitalization, clinically severe disease, mechanical ventilation, ICU admission, and mortality due to COVID-19. Therefore, it is important to increase awareness of these associations with obesity in COVID-19 patients.

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Association of use of remote patient monitoring (RPM) with reduced hospitalizations in cancer patients with COVID-19.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1503 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1503-1503

Author(s):

Joshua Pritchett ◽

Aakash Desai ◽

Bijan J Borah ◽

Zhuoer Xie ◽

Antoine N Saliba ◽

...

Keyword(s):

Hospital Admission ◽

Cancer Patients ◽

Clinical Outcomes ◽

Patient Monitoring ◽

Severe Illness ◽

Remote Patient Monitoring ◽

Hospital Admission Rate ◽

Icu Admission ◽

Remote Patient ◽

The Impact

1503 Background: Patients with cancer and COVID-19 are at risk for poor clinical outcomes. An established multi-site remote patient monitoring (RPM) service was rapidly adapted to support a novel, interdisciplinary COVID-19 program for outpatient management of patients at high-risk for severe illness. The goal of this study was to assess the impact of the RPM program on clinical outcomes and acute care utilization in cancer patients diagnosed with COVID-19. Methods: This is a cross-sectional analysis following a multi-site prospective observational study performed at Mayo Clinic Cancer Center (MCCC). All adult patients with active cancer – defined as currently receiving cancer-directed therapy or in recent remission on active surveillance – and PCR-confirmed SARS-CoV-2 infection between March 18 and July 31, 2020 were included. RPM was comprised of in-home technology to assess symptoms and physiologic data with centralized nurse and physician oversight. Results: During the study timeframe 224 cancer patients were diagnosed with COVID-19 at MCCC. Initial management included urgent hospitalization (within 48 hours of diagnosis) in 34 patients (15%). Of the remaining 190 patients (85%) initially managed in the outpatient setting, those who did not receive RPM were significantly more likely to experience hospitalization than those receiving RPM (OR 3.6, 95% CI 1.036 to 12.01, P = 0.044). Following balancing of patient characteristics by inverse propensity weighting, rates of hospital admission for RPM and non-RPM patients were 3.1% and 11% respectively, implying that RPM was associated with an 8% reduction in hospital admission rate (-0.077; 95% CI: -0.315 to -0.019, P = 0.009). Use of RPM was also associated with lower rates of prolonged hospitalization, ICU admission, and mortality, though these trends did not reach statistical significance. Conclusions: In the midst of a global pandemic associated with inpatient bed, ventilator, and PPE shortages, the RPM program provided an effective strategy for outpatient clinical management and was associated with decreased rates of hospitalization, ICU admission, and mortality in cancer patients with COVID-19. This care model enabled simultaneous opportunity to mitigate the increased risks of exposure, transmission, and resource utilization associated with conventional care.

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The prognostic value of B7H1 and B7H4 expression in pancreatic cancer: A meta-analysis

The International Journal of Biological Markers ◽

10.1177/1724600819881147 ◽

2019 ◽

Vol 34 (4) ◽

pp. 373-380 ◽

Cited By ~ 2

Author(s):

Zi-juan Qi ◽

Dan Yu ◽

Chun-hong Chen ◽

Hong Jiang ◽

Ran Li ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Prognostic Significance ◽

High Expression ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Poor Overall Survival ◽

Cancer Specific Survival ◽

Low Expression

Objective: The clinical implications of B7H1 and B7H4 in pancreatic cancer have been described however, the prognostic significance of these genes in pancreatic cancer patients remains inconclusive. The aim of the present study was to evaluate the prognostic role of B7H1 and B7H4 in pancreatic cancer patients. Methods: Electronic databases (PubMed, EMBASE, and the Cochrane Library) were searched for relevant articles published before May 2019. Meta-analyses were performed by pooling the hazard ratios (HRs) between overall survival or cancer-specific survival and high or low expression of B7H1/B7H4 in pancreatic cancer patients. Subgroup and sensitivity analyses were performed, and sources of variabilities were explored by performing meta-regression. Results: Sixteen studies (1434 patients’ data) were included. Compared with low expression, high expression of B7H1 was associated with significantly poor overall survival (HR 1.92 (95% confidence interval (CI) 1.35, 2.74); P<0.001) and cancer-specific survival (HR 2.46 (95% CI 1.55, 3.90); P<0.001). High expression of B7H4 also predicted poor overall survival (HR 2.38 (95% CI 1.89, 3.00); P<0.001). In subgroup analyses, a significant association between B7H1 and overall survival was observed for trials conducted in China (HR 2.08 (95% CI 1.29, 3.34)) but not in Japan (HR 1.98 (95% CI 1.33, 2.96)); or in studies with <50% patients having high expression (HR 2.02 (95% CI 1.40, 2.91)) but not in studies with >50% patients with high expression (HR 1.40 (95% CI 0.87, 2.26)). Conclusion: The current study suggests that high B7H1 and B7H4 expression is associated with a poor prognosis in pancreatic cancer patients.

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Clinical Characteristics and Outcomes of Venous Thromboembolism in Patients Hospitalized for COVID-19: Systematic Review and Meta-Analysis

10.1101/2020.06.14.20130922 ◽

2020 ◽

Cited By ~ 1

Author(s):

Joshua Henrina ◽

Iwan Cahyo Santosa Putra ◽

Irvan Cahyadi ◽

Hoo Felicia Hadi Gunawan ◽

Alius Cahyadi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Sensitivity Analysis ◽

Venous Thromboembolism ◽

Clinical Characteristics ◽

Meta Analysis ◽

White Blood Cells ◽

Male Gender ◽

Older Age ◽

Icu Admission ◽

D Dimer

ABSTRACTObjectiveTo investigate the clinical characteristics and outcomes of Coronavirus Disease of 2019 (COVID-19) patients complicated with venous thromboembolism (VTE)MethodWe performed a comprehensive literature search of several databases to find studies that assessed VTE in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE sufferers.ResultsEight studies have been included with a total of 1237 pooled subjects. Venous thromboembolism was associated with higher mortality (RR 2.48 (1.35, 4.55), p=0.003; I2 5%, p=0.35) after we performed sensitivity analysis, ICU admission (RR 2.32 (1.53, 3.52), p<0.0001; I2 80%, p <0.0001), and mechanical ventilation need (RR 2.73 (1.56, 4.78), p=0.0004; I2 77%, p=0.001). Furthermore, it was also associated to male gender (RR 1.21 (1.08, 1.35), p=0.0007; I2 12%, p=0.34), higher white blood cells count (MD 1.24 (0.08, 2.41), 0.04; I2 0%; 0.26), D-dimer (MD 4.49 (2.74, 6.25), p<0.00001; I2 67%, p=0.009) and LDH levels (MD 70.93 (19.33, 122.54), p<0.007; I2 21%, p=0.28). In addition, after sensitivity analysis was conducted, VTE also associated with older age (MD 2.79 (0.06, 5.53), p=0.05; I2 25%, p=0.24) and higher CRP levels (MD 2.57 (0.88, 4.26); p=0.003; I2 0%, p=0.96).ConclusionVenous thromboembolism in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male gender, older age, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE in COVID-19 patients during hospitalization.

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Incidence of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: A meta-analysis and meta-regression

British Journal of Surgery ◽

10.1093/bjs/znab202.022 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

L Orci ◽

B Caballol ◽

M Sanduzzi-Zamparelli ◽

V Sapena ◽

N Colucci ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Alcoholic Fatty Liver ◽

Meta Regression

Abstract Objective Nonalcoholic fatty liver disease (NAFLD) may be a risk factor for hepatocellular carcinoma (HCC), but the extent of this association still needs to be addressed. Pooled-incidence rates of HCC across the disease spectrum of NAFLD have never been estimated by meta-analysis. Methods In this systematic review, we searched Web of Science, Embase, Pubmed, and the Cochrane library from January 1st, 1950 through July 30th, 2020. We included studies reporting on HCC incidence in patients with NAFLD. The main outcomes were pooled HCC incidences in patients with NAFLD at distinct severity stages. Summary estimates were calculated with random-effects models. Sensitivity analyses and meta-regression analyses were carried out to address heterogeneity. The protocol for this review was registered in Prospero (CRD42018092861). Results Eighteen studies, with a total of 470,404 patients were included. In patients with NAFLD at a stage earlier than liver cirrhosis, HCC incidence was of 0.03 per 100 person-years (PYs) (95% confidence interval 0.01-0.07, I2=98%). This rate rose to 3.78 per 100PYs (2.47-5.78, I2=93%) when considering studies that only included patients with liver cirrhosis. Among the latter patients, those undergoing regular HCC screening displayed an incidence of 4.62 per 100PYs (2.77-7.72, I2= 77%). Conclusion Patients with NAFLD-related liver cirrhosis have a risk of developing HCC similar to that reported for patients with cirrhosis from other etiologies. Evidence documenting the risk in patients with NASH or simple steatosis is limited, but HCC incidence in these populations may lie below thresholds used to recommend HCC screening. Well-designed prospective studies in these subsets of patients are needed.

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