Cardiometabolic risk factors and clinical course of liver cirrhosis

Introduction

The global prevalence of Metabolic Dysfunction-Associated Liver Disease (MASLD) is dramatically increasing with the diffusion of cardiometabolic risk factors. The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of cardiometabolic risk factors (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia). Patients: 667 patients with liver cirrhosis (50 with MASLD aetiology, 167 with non-MASLD aetiology, and 450 with a non-MASLD etiological factor plus the presence of at least one cardiometabolic risk factor) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included.

Results

No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the MASLD or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients with non-MASLD cirrhosis, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent cardiometabolic factors, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality.

Conclusion

Compared to patients with non-MASLD cirrhosis, those with cardiometabolic risk factors had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.