Prevalence and prognosis of patients with MASLD‐related cirrhosis after an ICU hospitalization in France: A single‐centre prospective study

Summary Background and Aims The prevalence of metabolic dysfunction‐associated steatotic liver disease (MASLD)‐related cirrhosis has been increasing these last decades. There are no data regarding the prevalence of MASLD‐related cirrhosis in intensive care unit (ICU). Methods Prospective single‐centre study in a cohort of patients hospitalized in the ICU of Hepatology La Pitié‐Salpêtrière Hospital between January 2019 and September 2021. We analysed three groups of patients: MASLD‐cirrhosis (alcohol ≤210 g for men and 140 g weekly for women), ALD (alcohol‐related liver disease, alcohol>140 g weekly for women or >210 g for men)‐cirrhosis alone and MetALD (metabolic and alcohol‐related liver disease)‐cirrhosis. Endpoints were 1‐year transplant‐free survival (TFS), further acute decompensation (AD) and re‐admission. Results A total of 410 patients were hospitalized, and 315 analysed: 39 in MASLD, 160 in ALD and 116 in MetALD groups. The global prevalence was 10% for MASLD, 41% ALD and 29.7% for MetALD. Patients in the MASLD group were significantly older (65 vs. 57 and 59 years, p < 0.001), and had lower Child‐Pugh (8 vs. 11 vs. 10, p < 0.001) and MELD score (17 vs. 22 vs. 21, p < 0.001). The 1‐year TFS was not different between groups (53% vs. 54% vs. 54%, p = 0.96). Cardiovascular mortality was <5% in all groups. The 1‐year probability of developing hepatic encephalopathy was significantly higher in the MASLD group (73% vs. 27% and 21%, p < 0.001). There was no difference regarding the development of other complications between groups. Conclusion MASLD or MetALD was responsible for 1/3 of the causes of cirrhosis in the ICU. MASLD‐related cirrhosis is as severe as ALD‐related cirrhosis. Liver transplantation should be rapidly discussed.