Tada Toshifumi, Kumada Takashi, Toyoda Hidenori, Yasuda Satoshi, Koshiyama Yuichi, Akita Tomoyuki, Kodama Yuzo, Tanaka Junko
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
Hepatol Res. 2025 Jan 19. doi: 10.1111/hepr.14164.
In patients with metabolic dysfunction-associated steatotic liver disease (MASLD), the prognosis and outcomes, particularly non-liver-related mortality, remain insufficiently elucidated. We investigated all-cause mortality in patients with MASLD to elucidate the association of the severity of liver fibrosis with liver-related and non-liver-related mortality in MASLD.
Among 4528 participants with MASLD, we examined the causes of death and analyzed liver-related and non-liver-related mortality, stratified by the degree of fibrosis using the competing risk method. Fibrosis severity was assessed using the Fibrosis-4 (FIB-4) and FIB-3 indices.
The median follow-up period was 11.7 years. Of the 4528 participants, 551 died during the follow-up period, with only 37 (6.7%) deaths attributable to liver-related diseases and 514 (93.3%) to non-liver-related causes. For the risk of hepatocellular carcinoma, the hazard ratios (HRs; 95% confidence interval [CI]) for FIB-4 were 5.67 (2.20-14.59) and 32.14 (12.40-83.35) and for FIB-3 were 5.43 (2.73-10.79) and 19.96 (10.50-37.93). For liver-related mortality, the HRs (95% CI) for FIB-4 were 6.32 (2.23-17.85) and 27.62 (9.74-78.37) and for FIB-3 were 7.15 (2.62-19.50) and 19.86 (8.12-48.55), respectively. In contrast, intermediate and high FIB-4 and FIB-3 indices were unassociated with non-liver-related mortality: HRs (95% CI) for FIB-4 were 0.85 (0.70-1.04) and 0.87 (0.64-1.18), and for FIB-3 were 0.96 (0.77-1.20) and 0.92 (95% CI, 0.64-1.31), respectively.
The progression of liver fibrosis was unassociated with mortality from non-liver-related causes in patients with MASLD.
在代谢功能障碍相关脂肪性肝病（MASLD）患者中，其预后和结局，尤其是非肝脏相关死亡率，仍未得到充分阐明。我们调查了MASLD患者的全因死亡率，以阐明肝纤维化严重程度与MASLD患者肝脏相关和非肝脏相关死亡率之间的关联。
在4528例MASLD参与者中，我们检查了死亡原因，并使用竞争风险法按纤维化程度分层分析了肝脏相关和非肝脏相关死亡率。使用纤维化-4（FIB-4）和FIB-3指数评估纤维化严重程度。
中位随访期为11.7年。在4528名参与者中，551人在随访期间死亡，其中只有37人（6.7%）死于肝脏相关疾病，514人（93.3%）死于非肝脏相关原因。对于肝细胞癌风险，FIB-4的风险比（HRs；95%置信区间[CI]）分别为5.67（2.20-14.59）和32.14（12.40-83.35），FIB-3的风险比分别为5.43（2.73-10.79）和19.96（10.50-37.93）。对于肝脏相关死亡率，FIB-4的HRs（95%CI）分别为6.32（2.23-17.85）和27.62（9.74-78.37），FIB-3的HRs分别为7.15（2.62-19.50）和19.86（8.12-48.55）。相比之下，中等和高FIB-4及FIB-3指数与非肝脏相关死亡率无关：FIB-4的HRs（95%CI）分别为0.85（0.70-1.04）和0.87（0.64-1.18），FIB-3的HRs分别为0.96（0.77-1.20）和0.92（95%CI，0.64-1.31）。
MASLD患者肝纤维化的进展与非肝脏相关原因导致的死亡率无关。
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