Swaroop Shekhar, Biswas Sagnik, Mehta Shubham, Aggarwal Arnav, Arora Umang, Agarwal Samagra, Chavan Amitkumar, Nayak Baibaswata
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, Delhi, India.
J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102559. doi: 10.1016/j.jceh.2025.102559. Epub 2025 Apr 8.
The long-term impact of individual cardiometabolic risk factors (CMRFs) and their combinations on outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains poorly defined.
In this single-center retrospective analysis, all consecutive patients diagnosed with MASLD from August 2001 to January 2024 were included. CMRFs were defined as per established criteria, with body mass index threshold of 23 kg/m. Liver-related events (LREs) included ascites, hepatic encephalopathy (HE), variceal bleeding, hepatocellular carcinoma, and liver-related mortality. Rates of LREs and mortality were compared across CMRF combinations, and predictors were evaluated.
Of 1395 screened patients, 1043 were analyzed (median follow-up: 5.3 (3.8-6.7) years). LREs occurred in 30 (2.9%) patients, with an incidence of 5.04 (3.48-7.30) per 1000 person-years (PY). All-cause mortality occurred in 32 (3.0%) patients, with an incidence of 5.36 (95% CI: 3.79-7.58) per 1000 PY, including 14 (1.3%) liver-related mortality. Among individual CMRFs, diabetes was associated with the greatest proportion of mortality (4.1%), LREs (7.0%), and extrahepatic events (4.5%), while dyslipidemia was associated with the lowest proportions (2.4%, 2.4% and 2.2%, respectively). Patients with all five CMRFs had the highest rates of all-cause mortality (13.6 per 1000 PY) and LREs (8.8 per 1000 PY), though these differences were not statistically significant compared to those with fewer CMRFs. When assessing CMRF combinations, those with hypertension, low high density lipoprotein, obesity, and diabetes had the highest LRE (17.4 per 1000 PY) and all-cause mortality (21.1 per 1000 PY). Liver stiffness measurement (LSM) ≥10 kPa was an independent predictor of LRE and all-cause mortality.
The type of CMRF plays a more critical role than the number of CMRFs in determining MASLD outcomes. Among the CMRFs, diabetes is associated with higher rates of LREs and deaths in patients with MASLD. LSM ≥10 kPa is a key predictor of clinical outcomes.
个体心血管代谢危险因素（CMRFs）及其组合对代谢功能障碍相关脂肪性肝病（MASLD）患者预后的长期影响仍不明确。
在这项单中心回顾性分析中，纳入了2001年8月至2024年1月期间所有连续诊断为MASLD的患者。CMRFs根据既定标准定义，体重指数阈值为23kg/m²。肝脏相关事件（LREs）包括腹水、肝性脑病（HE）、静脉曲张出血、肝细胞癌和肝脏相关死亡率。比较不同CMRF组合的LREs和死亡率，并评估预测因素。
在1395例筛查患者中，对1043例进行了分析（中位随访时间：5.3（3.8 - 6.7）年）。30例（2.9%）患者发生LREs，每1000人年（PY）的发生率为5.04（3.48 - 7.30）。32例（3.0%）患者发生全因死亡，每1000 PY的发生率为5.36（95%CI：3.79 - 7.58），其中14例（1.3%）为肝脏相关死亡。在个体CMRFs中，糖尿病与最高比例的死亡率（4.1%）、LREs（7.0%）和肝外事件（4.5%）相关，而血脂异常与最低比例相关（分别为2.4%、2.4%和2.2%）。所有五项CMRFs的患者全因死亡率（每1000 PY为13.6）和LREs发生率（每1000 PY为8.8）最高，尽管与CMRFs较少的患者相比，这些差异无统计学意义。在评估CMRF组合时，患有高血压、低高密度脂蛋白、肥胖和糖尿病的患者LREs发生率最高（每1000 PY为17.4），全因死亡率最高（每1000 PY为21.1）。肝脏硬度测量（LSM）≥10 kPa是LREs和全因死亡率的独立预测因素。
在决定MASLD预后方面，CMRF的类型比其数量起着更关键的作用。在CMRFs中，糖尿病与MASLD患者较高的LREs发生率和死亡率相关。LSM≥10 kPa是临床预后的关键预测因素。
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