{"title":"日本活组织检查证实代谢功能障碍相关脂肪变性肝病患者肝纤维化与病因特异性死亡率之间的关系：一项前瞻性队列研究/日本MASLD患者肝纤维化与死亡率","authors":"Kyoko Sakai, Toshihide Shima, Hirohisa Oya, Takahiro Miura, Shohei Amioka, Takahiro Nonaka, Shinsaku Fujiishi, Keiichiro Okuda, Kei Terasaki, Kohei Fukumoto, Yasuhide Mitsumoto, Masayuki Mizuno, Takeshi Okanoue","doi":"10.1111/hepr.70034","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study examined mortality patterns and their association with liver fibrosis in Japanese patients with biopsy-confirmed metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>We analyzed 1104 MASLD-eligible individuals from the Suita SLD cohort (2004-2023). Mortality rates were assessed using Kaplan-Meier analysis and compared between patients with and without fibrosis (Stages 1-4 vs. 0) and between metabolic dysfunction-associated steatohepatitis (MASH) and non-MASH groups, adjusting for age and sex. Associations between fibrosis or inflammation levels and cause-specific mortality were also evaluated.</p><p><strong>Results: </strong>Of the initial 1109 patients, 1104 met the MASLD criteria. Among these patients (544 men, 560 women; mean age: 57.2 years; mean follow-up period: 6.9 years), 93 patients died, primarily from hepatocellular carcinoma (HCC) (n = 17), liver failure (n = 16), extrahepatic malignancies (n = 17), cardio-cerebrovascular diseases (n = 7), and other causes (n = 36). Fibrosis was associated with higher all-cause (11.4% vs. 3.6%) and liver-related mortality (4.8% vs. 0%, both p < 0.0001), but not with nonliver-related mortality after adjustment. All-cause mortality was higher in the MASH group (11.2% vs. 2.6%, p < 0.0001), with increased risk of both liver- and nonliver-related deaths (adjusted hazard ratios: liver-related = 1.34 × 10<sup>17</sup>, 95% CI: NE, nonliver-related = 2.20, 95% confidence interval [CI]: 1.07-4.53).</p><p><strong>Conclusion: </strong>HCC and extrahepatic malignancies were the leading causes of death in Japanese patients with MASLD. Liver fibrosis was a significant predictor of both all-cause and liver-related mortalities, but not nonliver-related mortality, highlighting its importance in follow-up strategies for MASLD. MASH may contribute to increased nonliver-related deaths. Further long-term studies are warranted.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Liver Fibrosis and Cause-Specific Mortality in Japanese Patients With Biopsy-Confirmed Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Cohort Study / Liver Fibrosis and Mortality in Japanese MASLD.\",\"authors\":\"Kyoko Sakai, Toshihide Shima, Hirohisa Oya, Takahiro Miura, Shohei Amioka, Takahiro Nonaka, Shinsaku Fujiishi, Keiichiro Okuda, Kei Terasaki, Kohei Fukumoto, Yasuhide Mitsumoto, Masayuki Mizuno, Takeshi Okanoue\",\"doi\":\"10.1111/hepr.70034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study examined mortality patterns and their association with liver fibrosis in Japanese patients with biopsy-confirmed metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>We analyzed 1104 MASLD-eligible individuals from the Suita SLD cohort (2004-2023). Mortality rates were assessed using Kaplan-Meier analysis and compared between patients with and without fibrosis (Stages 1-4 vs. 0) and between metabolic dysfunction-associated steatohepatitis (MASH) and non-MASH groups, adjusting for age and sex. Associations between fibrosis or inflammation levels and cause-specific mortality were also evaluated.</p><p><strong>Results: </strong>Of the initial 1109 patients, 1104 met the MASLD criteria. Among these patients (544 men, 560 women; mean age: 57.2 years; mean follow-up period: 6.9 years), 93 patients died, primarily from hepatocellular carcinoma (HCC) (n = 17), liver failure (n = 16), extrahepatic malignancies (n = 17), cardio-cerebrovascular diseases (n = 7), and other causes (n = 36). Fibrosis was associated with higher all-cause (11.4% vs. 3.6%) and liver-related mortality (4.8% vs. 0%, both p < 0.0001), but not with nonliver-related mortality after adjustment. All-cause mortality was higher in the MASH group (11.2% vs. 2.6%, p < 0.0001), with increased risk of both liver- and nonliver-related deaths (adjusted hazard ratios: liver-related = 1.34 × 10<sup>17</sup>, 95% CI: NE, nonliver-related = 2.20, 95% confidence interval [CI]: 1.07-4.53).</p><p><strong>Conclusion: </strong>HCC and extrahepatic malignancies were the leading causes of death in Japanese patients with MASLD. Liver fibrosis was a significant predictor of both all-cause and liver-related mortalities, but not nonliver-related mortality, highlighting its importance in follow-up strategies for MASLD. MASH may contribute to increased nonliver-related deaths. Further long-term studies are warranted.</p>\",\"PeriodicalId\":12987,\"journal\":{\"name\":\"Hepatology Research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hepatology Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/hepr.70034\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatology Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/hepr.70034","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Association Between Liver Fibrosis and Cause-Specific Mortality in Japanese Patients With Biopsy-Confirmed Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Cohort Study / Liver Fibrosis and Mortality in Japanese MASLD.
Background: This study examined mortality patterns and their association with liver fibrosis in Japanese patients with biopsy-confirmed metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: We analyzed 1104 MASLD-eligible individuals from the Suita SLD cohort (2004-2023). Mortality rates were assessed using Kaplan-Meier analysis and compared between patients with and without fibrosis (Stages 1-4 vs. 0) and between metabolic dysfunction-associated steatohepatitis (MASH) and non-MASH groups, adjusting for age and sex. Associations between fibrosis or inflammation levels and cause-specific mortality were also evaluated.
Results: Of the initial 1109 patients, 1104 met the MASLD criteria. Among these patients (544 men, 560 women; mean age: 57.2 years; mean follow-up period: 6.9 years), 93 patients died, primarily from hepatocellular carcinoma (HCC) (n = 17), liver failure (n = 16), extrahepatic malignancies (n = 17), cardio-cerebrovascular diseases (n = 7), and other causes (n = 36). Fibrosis was associated with higher all-cause (11.4% vs. 3.6%) and liver-related mortality (4.8% vs. 0%, both p < 0.0001), but not with nonliver-related mortality after adjustment. All-cause mortality was higher in the MASH group (11.2% vs. 2.6%, p < 0.0001), with increased risk of both liver- and nonliver-related deaths (adjusted hazard ratios: liver-related = 1.34 × 1017, 95% CI: NE, nonliver-related = 2.20, 95% confidence interval [CI]: 1.07-4.53).
Conclusion: HCC and extrahepatic malignancies were the leading causes of death in Japanese patients with MASLD. Liver fibrosis was a significant predictor of both all-cause and liver-related mortalities, but not nonliver-related mortality, highlighting its importance in follow-up strategies for MASLD. MASH may contribute to increased nonliver-related deaths. Further long-term studies are warranted.
期刊介绍：
Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.
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