Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
MASLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Deigo, La Jolla, California, USA.
Aliment Pharmacol Ther. 2024 Jul;60(1):61-69. doi: 10.1111/apt.18015. Epub 2024 Apr 25.
A multi-society consensus group proposed a new nomenclature for steatotic liver disease (SLD) including metabolic-dysfunction associated steatotic liver disease (MASLD), MASLD and increased alcohol intake (MetALD) and alcohol-associated liver disease (ALD). However, the risk of liver-related events, major adverse cardiovascular events (MACE) and all-cause mortality among various sub-groups is unknown.
To evaluate the risk of liver-related events, MACE and death among patients with SLD.
We conducted a nationwide, population-based study and enrolled 761,400 patients diagnosed with MASLD, MetALD or ALD. The primary endpoint was the occurrence of liver-related events, MACE and death in patients with MASLD, MetALD and ALD.
The cumulative incidence of liver-related events and death were highest in ALD, followed by MetALD and MASLD (p < 0.001 for both liver-related events and death), while the incidence of MACE was highest in MASLD, followed by MetALD and ALD (p < 0.001). Using MASLD as the reference and adjusting for age, sex, smoking, diabetes mellitus, dyslipidaemia and hypertension, the adjusted hazard ratios (95% confidence intervals) for liver-related events, MACE and death in MetALD were 1.42 (1.1-1.8), 0.68 (0.63-0.73) and 1.13 (0.98-1.3), respectively. In ALD, they were 3.42 (2.6-4.6), 0.58 (0.49-0.67) and 1.60 (1.3-2.0), respectively, for liver-related events, MACE and death.
The new consensus nomenclature can be used to stratify the risk of complications and prognosis. The nomenclature is beneficial for risk stratification and identifying new mechanisms for disease-specific therapeutic implications.
一个多学会共识小组提出了一种新的脂肪性肝病命名法，包括代谢功能障碍相关脂肪性肝病（MASLD）、MASLD 伴酒精摄入增加（MetALD）和酒精相关性肝病（ALD）。然而，各种亚组的肝脏相关事件、主要不良心血管事件（MACE）和全因死亡率的风险尚不清楚。
评估 MASLD、MetALD 和 ALD 患者发生肝脏相关事件、MACE 和死亡的风险。
我们进行了一项全国性的基于人群的研究，共纳入 761400 例 MASLD、MetALD 或 ALD 患者。主要终点是 MASLD、MetALD 和 ALD 患者发生肝脏相关事件、MACE 和死亡的情况。
肝脏相关事件和死亡的累积发生率在 ALD 中最高，其次是 MetALD 和 MASLD（肝脏相关事件和死亡均 < 0.001），而 MACE 的发生率在 MASLD 中最高，其次是 MetALD 和 ALD（均 < 0.001）。以 MASLD 为参照，调整年龄、性别、吸烟、糖尿病、血脂异常和高血压后，MetALD 患者肝脏相关事件、MACE 和死亡的校正风险比（95%置信区间）分别为 1.42（1.1-1.8）、0.68（0.63-0.73）和 1.13（0.98-1.3）。在 ALD 中，肝脏相关事件、MACE 和死亡的校正风险比分别为 3.42（2.6-4.6）、0.58（0.49-0.67）和 1.60（1.3-2.0）。
新的共识命名法可用于分层并发症和预后的风险。该命名法有利于风险分层和识别针对特定疾病的新机制的治疗意义。
