Histological disease progression in patients with metabolic dysfunction-associated steatotic liver disease using paired liver biopsy.

Background and aims: The aims of the present study were to assess the histological evolution of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) using paired liver biopsies, identify the factors associated with fibrosis and clinical disease progression, and determine the relationship between histological progression and clinical outcomes.

Methods: This was a single-center study. A total of 114 patients with MASLD who had at least two liver biopsies were included in the analysis.

Results: From baseline to follow-up biopsy, 44% of patients showed histological progression. Fibrosis progressed in 28 patients, regressed in 21, and showed no change in 65. The proportion of metabolic dysfunction-associated steatohepatitis (MASH) increased from 83% to 90%, with 95% of MASH patients remaining MASH and 70% of MASL patients fulfilling MASH criteria at follow-up biopsy. Among MASL patients with progression, 87% had lobular inflammation at baseline. During the median follow-up of 10 years, half of the patients with MASLD showed clinical progression, with 73% having MASH at baseline. No new metabolic abnormality developed in patients with MASL who maintained MASL status at follow-up. Multivariable logistic regression analysis showed that baseline hypertension (Odds Ratio [OR]: 2.611, p = 0.024) and high serum ALT levels (OR: 2.815, p = 0.049) were predictors of clinical progression in patients with MASLD.

Conclusions: Patients with MASLD, MASL, and MASH, exhibit disease progression. Hypertension and baseline abnormal liver injury test results are predictors of clinical disease progression in patients with MASLD.