An updated systematic review and meta-analysis: correlation between circulating plasminogen activator inhibitor-1 levels and metabolic dysfunction-associated steatotic liver disease.

Background Metabolic dysfunction-associated steatotic liver disease (MASLD)-formerly known as non-alcoholic fatty liver disease-is the leading cause of chronic liver disease globally. However, early diagnosis and specific treatment have not yet been achieved. Plasminogen activator inhibitor-1 (PAI-1) is closely related to MASLD and may be an important indicator for its diagnosis and treatment. This updated meta-analysis aimed to comprehensively explore the relationship between circulating PAI-1 levels and MASLD. Methods Article retrieval was carried out in seven provenances (PubMed, Cochrane Library, EMBASE, CNKI, WANFANG, Clinical Trials Database, and Grey Literature Database) using free text words and MeSH terms. The meta-analysis was performed using RevMan 5.3 and Stata 12. Outcomes were presented as standardised mean difference (SMD) with 95% confidence intervals (CI). Results A total of 23 studies were included in the meta-analysis. The levels of circulating PAI-1 in patients with MASLD were significantly higher than those in healthy controls (SMD = 1.44, 95% CI [1.06, 1.83]). Subgroup and meta-regression analyses based on key factors, such as area, age, and BMI, were performed to explore the sources of heterogeneity. In the BMI subgroup analysis, the participants were divided into two groups. While the subgroup results were inconclusive, the meta-regression suggested that the area (i.e. the geographic region of the study population) may be a major contributor to heterogeneity (p < 0.001). Conclusions Patients with MASLD have significantly high circulating PAI-1 levels; however, this correlation may vary in different regions, thereby providing a reference for further research on MASLD.