ACCELERATED PROGRESSION TO CIRRHOSIS AND HEPATIC DECOMPENSATION IN METALD AND ALD COMPARED TO MASLD: A GLOBAL STUDY

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101952

Luis Antonio Díaz Piga , Xiao-Dong Zhou , Natalia Baeza , Francisco Idalsoaga , Gustavo Ayares , Terry Cheuk-Fung Yip , Vincent Wai-Sun Wong , Grace Lai-Hung Wong , Jimmy Che-To Lai , Rakhi Maiwall , Shiv K. Sarin , Yu Jun Wong , Xin En Goh , May Xuan Goh , David Marti-Aguado , Cristiane Villela-Nogueira , Ana Carolina Cardoso , Natalia Balassiano Wajsbrot , Nathalie Leite , Gil Fernando Salles , Juan Pablo Arab

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Abstract

Introduction and Objectives

The natural history of MetALD remains poorly characterized. In a large global cohort, we compared the natural history of the main steatotic liver disease (SLD) subtypes in terms of liver fibrosis progression and hepatic decompensation.

Materials and Methods

Retrospective cohort study of adult participants with SLD (2003–2025), including MASLD, MetALD, and ALD according to the 2023 SLD criteria. Sociodemographic and clinical data, vibration-controlled transient elastography (VCTE) parameters, and liver biopsy (when available) were recorded. Other causes of liver disease were excluded. The primary outcome was progression to cirrhosis in those without cirrhosis at baseline (defined by 1. liver biopsy, or 2. VCTE ≥13.6 kPa, or Fibrosis-4 [FIB-4] >3.25 if other techniques were missing). Secondary outcomes included incidence of hepatic decompensation (ascites, hepatic encephalopathy, variceal bleeding, or hepatorenal syndrome). A multivariable Cox regression adjusted by age, sex, race, body mass index, diabetes, hypertension, hyperlipidemia, and smoking (for HCC) was performed.

Results

The total cohort included 150,306 participants from 15 countries; 87.5% MASLD, 7.9% MetALD, and 4.6% ALD. Overall, the median age was 61 years [IQR 51–70]; 52.8% men, and 97.6% Asian. At baseline, 12.2% of the cohort had a liver biopsy with F4 or a VCTE/FIB-4 suggestive of cirrhosis. During a median follow-up of 2.1 years [IQR 0.6–4.7], 0.9% of participants progressed to cirrhosis and 0.4% had hepatic decompensations. Individuals with MetALD and ALD exhibited a higher risk of progression to cirrhosis (MetALD aHR 1.34, 95%CI: 1.06–1.68, p=0.013; ALD aHR 1.82, 95%CI: 1.41–2.35, p<0.0001; MASLD: reference) and of hepatic decompensation (MetALD aHR 9.33, 95%CI: 6.32–13.75, p<0.0001; ALD aHR 20.56, 95%CI: 13.86–30.48, p<0.0001).

Conclusions

In this multi-ethnic global cohort, MetALD and ALD were associated with more rapid cirrhosis progression and greater decompensation rates than MASLD, independent of cardiometabolic factors.

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与masld相比，金属和ald加速肝硬化和肝脏失代偿进展：一项全球研究

介绍和目的MetALD的自然历史仍然不清楚。在一个大型的全球队列中，我们比较了主要脂肪变性肝病（SLD）亚型在肝纤维化进展和肝脏失代偿方面的自然历史。材料与方法回顾性队列研究成人SLD患者（2003-2025），包括MASLD、MetALD和ALD，根据2023 SLD标准。记录社会人口学和临床数据、振动控制瞬态弹性成像（VCTE）参数和肝脏活检（如果有的话）。排除了其他肝脏疾病的原因。主要结局是基线时无肝硬化的患者进展为肝硬化(定义为1。肝脏活检，或2。VCTE≥13.6 kPa，如果没有其他技术，则为Fibrosis-4 [FIB-4] >；3.25)。次要结局包括肝功能失代偿发生率（腹水、肝性脑病、静脉曲张出血或肝肾综合征）。对年龄、性别、种族、体重指数、糖尿病、高血压、高脂血症和吸烟（HCC）进行多变量Cox回归校正。结果总队列包括来自15个国家的150,306名参与者；87.5% MASLD, 7.9% MetALD, 4.6% ALD。总体而言，中位年龄为61岁[IQR 51-70]；52.8%是男性，97.6%是亚洲人。在基线时，12.2%的队列进行了F4或VCTE/FIB-4提示肝硬化的肝活检。在中位随访2.1年[IQR 0.6-4.7]期间，0.9%的参与者进展为肝硬化，0.4%的参与者出现肝功能失代偿。患有MetALD和ALD的个体表现出更高的肝硬化进展风险（MetALD aHR 1.34, 95%CI: 1.06-1.68, p=0.013; ALD aHR 1.82, 95%CI: 1.41-2.35, p= 0.0001； MASLD：参考）和肝功能失代偿（MetALD aHR 9.33, 95%CI: 6.32-13.75, p= 0.0001; ALD aHR 20.56, 95%CI: 13.86-30.48, p= 0.0001）。结论：在这个多种族的全球队列中，与MASLD相比，MetALD和ALD与更快的肝硬化进展和更大的失代偿率相关，且与心脏代谢因素无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.