Liver-related Events and Outcomes in Patients With Metabolic Dysfunction-associated Steatotic Liver Disease Varies With the Type of Cardiometabolic Risk Factor

Abstract

Background

The long-term impact of individual cardiometabolic risk factors (CMRFs) and their combinations on outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains poorly defined.

Methods

In this single-center retrospective analysis, all consecutive patients diagnosed with MASLD from August 2001 to January 2024 were included. CMRFs were defined as per established criteria, with body mass index threshold of 23 kg/m². Liver-related events (LREs) included ascites, hepatic encephalopathy (HE), variceal bleeding, hepatocellular carcinoma, and liver-related mortality. Rates of LREs and mortality were compared across CMRF combinations, and predictors were evaluated.

Results

Of 1395 screened patients, 1043 were analyzed (median follow-up: 5.3 (3.8–6.7) years). LREs occurred in 30 (2.9%) patients, with an incidence of 5.04 (3.48–7.30) per 1000 person-years (PY). All-cause mortality occurred in 32 (3.0%) patients, with an incidence of 5.36 (95% CI: 3.79–7.58) per 1000 PY, including 14 (1.3%) liver-related mortality. Among individual CMRFs, diabetes was associated with the greatest proportion of mortality (4.1%), LREs (7.0%), and extrahepatic events (4.5%), while dyslipidemia was associated with the lowest proportions (2.4%, 2.4% and 2.2%, respectively). Patients with all five CMRFs had the highest rates of all-cause mortality (13.6 per 1000 PY) and LREs (8.8 per 1000 PY), though these differences were not statistically significant compared to those with fewer CMRFs. When assessing CMRF combinations, those with hypertension, low high density lipoprotein, obesity, and diabetes had the highest LRE (17.4 per 1000 PY) and all-cause mortality (21.1 per 1000 PY). Liver stiffness measurement (LSM) ≥10 kPa was an independent predictor of LRE and all-cause mortality.

Conclusion

The type of CMRF plays a more critical role than the number of CMRFs in determining MASLD outcomes. Among the CMRFs, diabetes is associated with higher rates of LREs and deaths in patients with MASLD. LSM ≥10 kPa is a key predictor of clinical outcomes.