Association of metabolic vulnerability index with various chronic liver diseases and mortality: a large prospective cohort study

The association between metabolic vulnerability index (MVX), a composite biomarker integrating inflammatory and metabolic pathways, and chronic liver diseases (CLDs) is still unclear. This prospective cohort study included 255,171 participants from the UK Biobank, with a median follow-up period of 13.71 years. Multivariable-adjusted cox proportional hazards models, restricted cubic splines (RCS) and sensitivity analyses were used to evaluate the association between MVX and CLDs. This study showed that higher levels of MVX (Q4 vs Q1) significantly increased the risk of CLDs after adjusted by socio-demographic and health status factors (all P < 0.05): cirrhosis (HR = 1.60, 95%CI:1.38–1.86), alcoholic-related liver disease (HR = 1.34, 95%CI:1.07–1.68), autoimmune liver disease (HR = 1.35, 95%CI:1.12–1.62), liver and biliary tract cancer (HR = 1.32, 95%CI:1.05–1.66), liver disease-related death (HR = 2.11, 95%CI:1.59–2.80), and all-cause mortality (HR = 1.17, 95%CI:1.13–1.21). No association was found between MVX and viral hepatitis. RCS and threshold analysis showed a reverse L-shaped association between MVX and cirrhosis and liver-related deaths, a linearly increasing association with AILD and LBC, and a J-shaped association with ALD and all-cause mortality. Subgroups analysis and sensitivity analyses demonstrated stable correlation between MVX and CLDs and death events. MVX is a promising indicator for independently predicting CLD events, liver-related mortality, and all-cause mortality. As a marker of metabolic-inflammatory dysregulation, MVX may enable early identification of high-risk individuals for targeted primary prevention of CLDs.