Natural history of clinical outcomes and hepatic decompensation in metabolic dysfunction-associated steatotic liver disease

Nabil Noureddin; Daniel Q Huang; Ricki Bettencourt; Harris Siddiqi; Abdul M Majzoub; Tarek Nayfeh; Nobuharu Tamaki; Namiki Izumi; Atsushi Nakajima; Ramazan Idilman; Mesut Gumussoy; Digdem Kuru Oz; Ayse Erden; Tolga Gidener; Alina M Allen; Veeral Ajmera; Rohit Loomba

doi:10.1111/apt.17981

Natural history of clinical outcomes and hepatic decompensation in metabolic dysfunction-associated steatotic liver disease

Aliment Pharmacol Ther. 2024 Apr 3. doi: 10.1111/apt.17981. Online ahead of print.

Authors

Nabil Noureddin^{1

2}, Daniel Q Huang^{1

3

4}, Ricki Bettencourt¹, Harris Siddiqi¹, Abdul M Majzoub⁵, Tarek Nayfeh⁵, Nobuharu Tamaki⁶, Namiki Izumi⁶, Atsushi Nakajima⁷, Ramazan Idilman⁸, Mesut Gumussoy⁸, Digdem Kuru Oz⁹, Ayse Erden⁹, Tolga Gidener¹⁰, Alina M Allen¹⁰, Veeral Ajmera^{1

2}, Rohit Loomba^{1

2

11}

Affiliations

¹ Department of Medicine, Division of Gastroenterology and Hepatology, MASLD Research Center, University of California at San Diego, La Jolla, California, USA.
² Department of Medicine, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, USA.
³ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore.
⁵ Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
⁷ Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan.
⁸ Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
⁹ Department of Radiology, Ankara University School of Medicine, Ankara, Turkey.
¹⁰ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Department of Medicine, The Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California, USA.

PMID: 38571305
DOI: 10.1111/apt.17981

Abstract

Background & aims: The natural progression of hepatic decompensation in metabolic dysfunction-associated steatotic liver disease (MASLD) is not well-characterised. We aimed to describe it by conducting a retrospective analysis.

Methods: This longitudinal, retrospective analysis of well-characterised MASLD cohorts followed for hepatic decompensation and death. The sequence of liver-related events was evaluated, and the median time between hepatic decompensation episodes and death versus. transplantation was measured.

Results: Of the 2016 patients identified, 220 (11%) developed at least one episode of hepatic decompensation during a median follow-up of 3.2 years. Ascites was the most common first liver-related event [153 (69.5%)], followed by hepatic encephalopathy (HE) [55 (25%)] and variceal haemorrhage (VH) [30 (13.6%)]. Eighteen out of the 220 (8.1%) patients had more than one liver-related event as their first hepatic decompensation. Among the patients who had the first episode, 87 (39.5%) had a second episode [44 (50.5%) HE, 31 (35.6%) ascites, and 12 (13.7%) VH]. Eighteen out of 220 (8.1%) had a third episode [10 (55.5%) HE, 6 (33.3%) VH, and 2 (11.1%) ascites]. Seventy-three out of 220 (33.1%) died, and 31 (14%) received liver transplantation. The median time from the first episode to the second was 0.7 years and 1.3 years from the second episode to the third. The median survival time from the first episode to death or transplantation was 2.0 years.

Conclusion: The most common first liver-related event in MASLD patients is ascites. The median survival from the first hepatic decompensation to either death or transplantation is 2 years.

Abstract

Grants and funding