Histological disease progression in patients with metabolic dysfunction–associated steatotic liver disease using paired liver biopsy

Background and aims The aims of the present study were to assess the histological evolution of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) using paired liver biopsies, identify the factors associated with fibrosis and clinical disease progression, and determine the relationship between histological progression and clinical outcomes. Methods This was a single-center study. A total of 114 patients with MASLD who had at least two liver biopsies were included in the analysis. Results From baseline to follow-up biopsy, 44% of patients showed histological progression. Fibrosis progressed in 28 patients, regressed in 21, and showed no change in 65. The proportion of metabolic dysfunction-associated steatohepatitis (MASH) increased from 83% to 90%, with 95% of MASH patients remaining MASH and 70% of MASL patients fulfilling MASH criteria at follow-up biopsy. Among MASL patients with progression, 87% had lobular inflammation at baseline. During the median follow-up of 10 years, half of the patients with MASLD showed clinical progression, with 73% having MASH at baseline. No new metabolic abnormality developed in patients with MASL who maintained MASL status at follow-up. Multivariable logistic regression analysis showed that baseline hypertension (Odds Ratio [OR]: 2.611, p = 0.024) and high serum ALT levels (OR: 2.815, p = 0.049) were predictors of clinical progression in patients with MASLD. Conclusions Patients with MASLD, MASL, and MASH, exhibit disease progression. Hypertension and baseline abnormal liver injury test results are predictors of clinical disease progression in patients with MASLD.