Combined effect of histological findings and diabetes mellitus on liver-related events in patients with metabolic dysfunction-associated steatotic liver disease

Akihito Shiomi; Teruki Miyake; Shinya Furukawa; Bunzo Matsuura; Osamu Yoshida; Takao Watanabe; Ayumi Kanamoto; Masumi Miyazaki; Hironobu Nakaguchi; Yoshio Tokumoto; Masashi Hirooka; Masanori Abe; Yoichi Hiasa

doi:10.1111/hepr.14049

Combined effect of histological findings and diabetes mellitus on liver-related events in patients with metabolic dysfunction-associated steatotic liver disease

Hepatol Res. 2024 Apr 24. doi: 10.1111/hepr.14049. Online ahead of print.

Affiliations

¹ Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
² Health Services Center, Ehime University, Matsuyama, Japan.
³ Department of Lifestyle-Related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Toon, Japan.

PMID: 38656764
DOI: 10.1111/hepr.14049

Abstract

Aim: Advanced fibrosis has a strong influence on the occurrence of liver-related events in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while diabetes mellitus (DM), which is often complicated by MASLD, is associated with the progression of MASLD. We stratified patients with MASLD according to the severity of liver pathological findings and the presence of DM, aiming to examine whether these indices could be used to accurately assess the risk of developing liver-related events.

Methods: A total of 282 patients with liver biopsy-proven MASLD were included. Liver-related events were defined as the occurrence of hepatocellular carcinoma (HCC) and complications of liver cirrhosis, such as ascites, hepatic encephalopathy, Child-Pugh class B and C, as well as treatment-eligible esophageal and gastric varices.

Results: Multivariate analysis adjusted for age, sex, body mass index, alanine aminotransferase, creatinine, hemoglobin A1c, smoking habits, dyslipidemia, hypertension, nonalcoholic fatty liver disease activity score (NAS), or fibrosis stage showed that advanced fibrosis with or without DM was a risk factor for liver-related events. The combined effect of DM and advanced fibrosis increased the risk of HCC onset. However, DM alone or in combination with NAS did not affect the development of liver-related events, including the occurrence of HCC and complications of liver cirrhosis.

Conclusions: While the assessment of fibrosis in patients with MASLD is important for evaluating the risk of developing liver-related events, combining the assessment of DM may be possible to stratify groups at higher risk of developing HCC.

Keywords: diabetes mellitus; fibrosis; liver; liver‐related event; metabolic dysfunction‐associated steatohepatitis; metabolic dysfunction‐associated steatotic liver disease.