Buttler Laura, Tiede Anja, Griemsmann Marie, Rieland Hannah, Mauz Jim B, Wedemeyer Heiner, Cornberg Markus, Tergast Tammo L, Hupa-Breier Katharina L, Maasoumy Benjamin
Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
German Centre for Infection Research (DZIF), partner-site Hannover-Braunschweig, Hannover, Germany.
PLoS One. 2025 Jun 26;20(6):e0325673. doi: 10.1371/journal.pone.0325673. eCollection 2025.
Recently, the new definition of steatotic liver disease (SLD) has been introduced, which not only differentiates MASLD (Metabolic Dysfunction-Associated steatotic liver disease) from alcohol-related steatotic liver disease (ALD), but also introduces the concept of metabolic and alcohol-related SLD (MetALD). However, potential differences of the new etiologies regarding the clinical phenotype of patients with advanced liver cirrhosis still remain undetermined. Therefore, we analyzed survival and the incidence of cirrhosis-related complications in SLD-patients with advanced liver cirrhosis.
A number of 416 consecutive patients with MASLD, MetALD- and ALD-associated decompensated liver cirrhosis were investigated. Overall survival, infections, hepatic encephalopathy, portal-hypertensive bleeding, rehospitalization and development of hepatocellular carcinoma were retrospectively analyzed within one year of follow-up. Cox regression analyses were performed for survival, competing risk analyses for the cirrhosis-specific complications. MASLD was used as reference group.
ALD was associated with a lower risk of infections (HR = 0.55; p < 0.001) compared to MASLD. This remained significant after adjustment for age, sex, Model for End-Stage Liver Disease (MELD), serum-sodium, serum-cholinesterase, diabetes, body mass index and norfloxacin (HR = 0.59; p = 0.02) in the multivariable competing risk model. Notably, the incidence of infections in MetALD patients was in between both groups (MetALD: 68.7%, ALD: 56.1%, MASLD: 87.3%). However, there were no differences in survival (MetALD: HR = 1.03; p = 0.93; ALD: HR = 0.79; p = 0.49) and the other complications studied here.
The risk of infections is increased in MASLD-associated cirrhosis compared to other SLD-phenotypes. Thus, the role of a metabolic risk profile should not be neglected even in patients with decompensated liver cirrhosis.
最近，脂肪性肝病（SLD）的新定义被引入，它不仅区分了代谢功能障碍相关脂肪性肝病（MASLD）与酒精性脂肪性肝病（ALD），还引入了代谢和酒精相关脂肪性肝病（MetALD）的概念。然而，关于晚期肝硬化患者临床表型的新病因的潜在差异仍未确定。因此，我们分析了晚期肝硬化SLD患者的生存率和肝硬化相关并发症的发生率。
对416例连续的MASLD、MetALD和ALD相关失代偿性肝硬化患者进行了研究。在随访的一年内，对总生存率、感染、肝性脑病、门静脉高压出血、再次住院和肝细胞癌的发生情况进行了回顾性分析。对生存率进行Cox回归分析，对肝硬化特异性并发症进行竞争风险分析。以MASLD作为参照组。
与MASLD相比，ALD患者感染风险较低（HR = 0.55；p < 0.001）。在多变量竞争风险模型中，调整年龄、性别、终末期肝病模型（MELD）、血清钠、血清胆碱酯酶、糖尿病、体重指数和诺氟沙星后，这一差异仍然显著（HR = 0.59；p = 0.02）。值得注意的是，MetALD患者的感染发生率介于两组之间（MetALD：68.7%；ALD：56.1%；MASLD：87.3%）。然而，在生存率（MetALD：HR = 1.03；p = 0.93；ALD：HR = 0.79；p = 0.49）和此处研究的其他并发症方面没有差异。
与其他SLD表型相比，MASLD相关肝硬化患者的感染风险增加。因此，即使在失代偿性肝硬化患者中，代谢风险谱的作用也不应被忽视。
