This study examined mortality patterns and their association with liver fibrosis in Japanese patients with biopsy-confirmed metabolic dysfunction-associated steatotic liver disease (MASLD). We analyzed 1104 MASLD-eligible individuals from the Suita SLD cohort (2004-2023). Mortality rates were assessed using Kaplan-Meier analysis and compared between patients with and without fibrosis (Stages 1-4 vs. 0) and between metabolic dysfunction-associated steatohepatitis (MASH) and non-MASH groups, adjusting for age and sex. Associations between fibrosis or inflammation levels and cause-specific mortality were also evaluated. Of the initial 1109 patients, 1104 met the MASLD criteria. Among these patients (544 men, 560 women; mean age: 57.2 years; mean follow-up period: 6.9 years), 93 patients died, primarily from hepatocellular carcinoma (HCC) (n = 17), liver failure (n = 16), extrahepatic malignancies (n = 17), cardio-cerebrovascular diseases (n = 7), and other causes (n = 36). Fibrosis was associated with higher all-cause (11.4% vs. 3.6%) and liver-related mortality (4.8% vs. 0%, both p < 0.0001), but not with nonliver-related mortality after adjustment. All-cause mortality was higher in the MASH group (11.2% vs. 2.6%, p < 0.0001), with increased risk of both liver- and nonliver-related deaths (adjusted hazard ratios: liver-related = 1.34 × 1017, 95% CI: NE, nonliver-related = 2.20, 95% confidence interval CI: 1.07-4.53). HCC and extrahepatic malignancies were the leading causes of death in Japanese patients with MASLD. Liver fibrosis was a significant predictor of both all-cause and liver-related mortalities, but not nonliver-related mortality, highlighting its importance in follow-up strategies for MASLD. MASH may contribute to increased nonliver-related deaths. Further long-term studies are warranted.
Sakai et al. (Mon,) studied this question.