Severe hepatic steatosis promotes increased liver stiffness in the early stages of metabolic dysfunction-associated steatotic liver disease

Takashi Kumada; Hidenori Toyoda; Sadanobu Ogawa; Tatsuya Gotoh; Yasuaki Suzuki; Katsutoshi Sugimoto; Yuichi Yoshida; Hidekatsu Kuroda; Yoshihiro Kamada; Yoshio Sumida; Takanori Ito; Tomoyuki Akita; Junko Tanaka

doi:10.1111/liv.15920

Severe hepatic steatosis promotes increased liver stiffness in the early stages of metabolic dysfunction-associated steatotic liver disease

Liver Int. 2024 Apr 1. doi: 10.1111/liv.15920. Online ahead of print.

Authors

Affiliations

¹ Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Gifu, Japan.
² Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
³ Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan.
⁴ Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan.
⁵ Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
⁶ Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan.
⁷ Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
⁸ Department of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
⁹ Department of Healthcare Management, International University of Health and Welfare, Tokyo, Japan.
¹⁰ Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
¹¹ Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan.

PMID: 38558221
DOI: 10.1111/liv.15920

Abstract

Background & aims: The predictors of progression from steatosis to more advanced stages of metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. We evaluated the association between the quantity of hepatic steatosis and longitudinal changes in liver stiffness measurements (LSMs) using magnetic resonance elastography (MRE) in patients with MASLD.

Methods: We retrospectively analysed patients with MASLD who underwent at least two serial MRE and magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) examinations at least 1 year apart. Fine-Gray competitive proportional hazard regression was used to identify LSM progression and regression factors.

Results: A total of 471 patients were enrolled. Factors linked to LSM progression were steatosis grade 3 (MRI-PDFF ≥17.1%, adjusted hazard ratio [aHR] 2.597; 95% confidence interval [CI] 1.483-4.547) and albumin-bilirubin grade 2 or 3 (aHR 2.790; 95% CI 1.284-6.091), while the only factor linked to LSM regression was % decrease rate of MRI-PDFF ≥5% (aHR 2.781; 95% CI 1.584-4.883). Steatosis grade 3 correlated with a higher incidence rate of LSM progression than steatosis grade 1 (MRI-PDFF <11.3%) in patients with LSM stage 0 (<2.5 kilopascal [kPa]), and a % annual decrease rate of MRI-PDFF ≥5% correlated with a higher incidence rate of LSM regression than that of MRI-PDFF >-5% and <5% in patients with LSM stage 1 or 2-4 (≥2.5 kPa).

Conclusions: Severe hepatic steatosis was linked to significant LSM progression in patients with MASLD and low LSM (<2.5 kPa).

Keywords: LSM (liver stiffness measurement); MASLD (metabolic dysfunction–associated steatotic liver disease); MRE (magnetic resonance elastography); MRI‐PDFF (magnetic resonance imaging–based proton density fat fraction).