The impact of first and further decompensation in patients with metabolic-dysfunction associated compensated advanced chronic liver disease

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
G. Pennisi , G. Di Maria , V. Wai-Sun Wong , V. de Ledinghen , G. Sebastiani , M. Viganò , A.L. Fracanzani , L. Miele , E. Bugianesi , M. Ekstedt , R. D'Ambrosio , F. Schepis , F. Marra , A.M. Aghemo , G. Svegliati-Baroni , M. Persico , L. Valenti , A. Berzigotti , J. George , F. Ravaioli , S. Petta
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引用次数: 0

Abstract

Background & Aim

The first and further decompensation mark the natural history and the risk of mortality in patients with cirrhosis. We assessed the cumulative incidence of first and further (acute and non-acute) decompensation and evaluated their impact on both liver-related death (LR-D) in patients with compensated advanced chronic liver disease (cACLD) due to metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

Consecutive patients with clinical (LSM>10 kPa) or biopsy-proven (F3-F4 fibrosis) diagnosis of cACLD due to MASLD were included. First and further decompensation were defined according to Baveno VII criteria. The acute (AD) and non-acute (NAD)[MOU1] [VW(2] presentation of the decompensation was also evaluated. Competing risk analysis and cumulative incidence functions (CIF) [MOU3] were assessed by Fine and Gray. Cause-specific Cox models with baseline and time-dependent variables were applied. Multistate model was built to better assess the clinical course of cACLD due to MASLD.

Results

The cumulative incidence of the first decompensation was 3.5% at 5 years, increasing 20-times the risk of LR-D at cause-specific Cox analysis; the cumulative incidence of further decompensation was 44% at 5 years among patients with first decompensation, additionally increasing 1.6-times the risk of LR-D. Ascites, followed by variceal bleeding, were the most common events in both first and further decompensation. The impact of AD and NAD as both first or further event on LR-D was similar[MOU4] . Hepatocellular carcinoma (HCC) further independently increased the risk of LR-D of 3.2-times and 1.6-times, respectively, in the whole cohort of cACLD due to MASLD and in those who experienced first decompensation.

Conclusions

The first and further decompensations (AD and NAD) represent tipping points in the clinical course of patients with cACLD due to MASLD, increasing 20-times and additionally 1.6-times the risk of LR-D. HCC is an independent predictor of LR-D in patients with cACLD due to MASLD, resulting in an additional risk of LR-D when associated with both first and further decompensation.

代谢功能障碍相关代偿性晚期慢性肝病患者首次失代偿和进一步失代偿的影响
背景& 目的首次和进一步失代偿标志着肝硬化患者的自然史和死亡风险。我们评估了代谢功能障碍相关性脂肪性肝病(MASLD)引起的代偿性晚期慢性肝病(cACLD)患者首次和进一步(急性和非急性)失代偿的累积发生率,并评估了它们对肝脏相关死亡(LR-D)的影响。方法纳入临床(LSM>10 kPa)或活检证实(F3-F4纤维化)诊断为代谢功能障碍相关性脂肪性肝病(MASLD)引起的代偿性晚期慢性肝病(cACLD)的连续患者。首次失代偿和进一步失代偿根据 Baveno VII 标准定义。还评估了失代偿的急性(AD)和非急性(NAD)[MOU1] [VW(2)]表现。Fine和Gray对竞争风险分析和累积发病率函数(CIF)[MOU3]进行了评估。应用了带有基线变量和时间变量的特定病因 Cox 模型。结果5年内首次失代偿的累积发生率为3.5%,按病因特异性Cox分析,LR-D风险增加了20倍;5年内首次失代偿患者进一步失代偿的累积发生率为44%,LR-D风险增加了1.6倍。腹水是首次失代偿和进一步失代偿中最常见的事件,其次是静脉曲张出血。AD和NAD对LR-D的影响相似[MOU4]。结论 首次和进一步失代偿(AD 和 NAD)是 MASLD 引起的 cACLD 患者临床病程的临界点,分别使 LR-D 风险增加了 20 倍和 1.6 倍。HCC是MASLD导致的cACLD患者发生LR-D的独立预测因素,当患者出现首次和进一步失代偿时,发生LR-D的风险会增加。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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