Hepatic Steatosis Estimated by VCTE-Derived CAP Scores Was Associated With Lower Risks of Liver-Related Events and All-Cause Mortality in Patients With Chronic Liver Diseases

INTRODUCTION: The controlled attenuated parameter (CAP) score derived from vibration-controlled transient elastography (VCTE, i.e., FibroScan) is a well-validated marker of hepatic steatosis. It is unclear whether CAP scores are associated with risks of liver-related outcomes or all-cause mortality. METHODS: In this retrospective cohort study, we identified 7,587 United States veterans (2,689 with cured hepatitis C hepatitis C virus, 1,523 with alcohol-associated liver disease, and 3,375 with metabolic dysfunction-associated steatotic liver disease MASLD) who underwent VCTE between May 2015 and December 2021. We followed patients for new hepatic decompensation, hepatocellular carcinoma, and death from the VCTE date until January 1, 2022. Multivariable Cox-proportional hazards regression was used to assess for the associations between CAP measurements and clinical outcomes, adjusting for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, diabetes, liver disease etiology, liver stiffness measurements, and Fibrosis-4 score, and was reported separately by disease etiology and advanced fibrosis status. RESULTS: Over a median follow-up time of ∼1.9 years, hepatic steatosis (grades 1-3 vs 0) was associated with a lower risk of death (adjusted hazard ratio aHR 0.70, 95% CI: 0.57-0.85). Among patients with MASLD, hepatic steatosis was associated with a lower risk of decompensation (aHR 0.54, 95% CI: 0.32-0.90) and death (aHR 0.52, 95% CI: 0.37-0.73). These associations persisted in subgroup analyses of patients with advanced fibrosis and without cirrhosis. DISCUSSION: Among patients who underwent VCTE in clinical practice, the presence of substantial hepatic steatosis estimated by the CAP score was associated with lower all-cause mortality among all patients and lower risk of decompensation and death among those with MASLD.