Fatty Liver Disease Nearly Doubles Mortality Risk

TOPLINE:

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) face significantly higher risks of dying from nearly all major causes, with the most pronounced relative risks observed for hepatocellular carcinoma (HCC) and liver-related deaths, and the highest absolute mortality rates for non-HCC cancer and cardiovascular disease.

METHODOLOGY:

• MASLD is the most common chronic liver disease and leading cause of liver-related illness and death. It’s also associated with several extrahepatic diseases. Most prior studies on cause-specific mortality in MASLD were small and restricted to liver-related mortality.
• Using Swedish registry data, researchers determined the rate and risk for death from 11 different causes in 13,099 patients with MASLD, matched to 118,884 control individuals from the general population based on age, sex, municipality, and calendar year.
• They used Cox regression to calculate hazard ratios (HRs) for 11 predefined causes of death, adjusting for education, country of birth, and comorbidities. Cumulative incidences were calculated using competing risk analysis to estimate absolute risks over 15 years.

TAKEAWAY:

• A total of 1628 (12.4%) deaths occurred in patients with MASLD and 9119 (7.7%) in control individuals during median follow-up of 4.7 years and 5.8 years, respectively.
• MASLD was associated with higher all-cause mortality (HR, 1.85), with 26.9% of MASLD patients dying from any cause within 15 years of diagnosis, compared with 16.9% of control individuals.
• MASLD was associated with higher rates of all specific causes of death except mental health disorder. The strongest relative associations between MASLD and mortality were for death from non-HCC liver disease (HR, 26.9) and HCC (HR, 35.0).
• The absolute risk for death in patients with MASLD was highest for non-HCC cancer (28.4% of all deaths), cardiovascular disease (25.9%) and non-HCC liver disease (10.8%), whereas 3.0% of deaths were due to HCC.

IN PRACTICE:

“Early multidisciplinary care may be needed to reduce premature mortality in patients with MASLD. Such multidisciplinary care may include various stakeholders including primary care physicians, nurses, allied health professionals, and specialists in hepatology, diabetes, obesity, cardiology, oncology, public health, and more, as well as the patients themselves,” the authors wrote.

Further, they said the estimates of absolute risks for death in their study “may be useful for clinicians and policymakers to inform patients about their prognosis and potentially implement clinical or public health strategies to reduce premature mortality.”

SOURCE:

This study, with first author Gabriel Issa, MD, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden, was published online on March 24 in the Journal of Hepatology.

LIMITATIONS:

MASLD cases were selected from inpatient or specialized outpatient care settings. The study did not include data from primary care, potentially selecting for more severe MASLD cases. MASLD is known to be under diagnosed, meaning some of the general population may also have had MASLD, possibly underestimating risk. The cause-of-death misclassification is also possible due to limitations in death certificates.

DISCLOSURES:

This study had no commercial funding. The authors reported no relevant conflicts of interest.