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December 16, 2025Hepatology

Cardiovascular–kidney–metabolic syndrome and the risk of liver fibrosis progression and liver-related events in MASLD

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Authors

XZXiaodong ZhouQCQin‐Fen ChenQFQi Fan

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Overview

Cohort study reveals advancing cardiovascular-kidney-metabolic stages drive liver fibrosis progression in MASLD, highlighting the need for early multi-organ risk management.

Key Points

  • To investigate the relationships between cardiovascular-kidney-metabolic (CKM) syndrome stages and liver fibrosis severity, progression, and the incidence of liver-related events in patients with MASLD.
  • Stratified N=12,097 patients with MASLD from the VCTE-Prognosis cohort into CKM stages 0-1, 2, and 3-4 across a median follow-up of 4.5 years.
  • Evaluated advanced liver fibrosis (LSM ≥10 kPa), liver stiffness progression (≥20% increase and Baveno category upshift), and incident liver-related events (LREs) using multivariable logistic regression and Cox proportional hazards models.
  • Advanced liver fibrosis prevalence increased with higher CKM stages (9.6% in stage 0-1, 18.0% in stage 2, and 31.6% in stage 3-4), with both stage 2 (adjusted OR=1.663, 95% CI 1.444-1.915) and stage 3-4 (adjusted OR=2.575, 95% CI 2.109-3.144) independently associated with advanced fibrosis.
  • Liver stiffness progression occurred in 6.1% of patients (n=716), showing increased risk in CKM stage 2 (adjusted HR=1.321, 95% CI 1.050-1.662; p=0.018) and stage 3-4 (adjusted HR=1.767, 95% CI 1.339-2.330; p<0.001) compared with stage 0-1.
  • Incident liver-related events developed in 1.7% of patients (n=352), with an elevated risk independently associated exclusively with CKM stage 3-4 (adjusted HR=1.975, 95% CI 1.245-3.133; p=0.004).

Cite This Study

Zhou et al. (2025) studied this question.

synapsesocial.com/papers/6aade6673d58b280b1b321b5https://doi.org/10.1097/hep.0000000000001645
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Abstract MPTH69: Metabolic Dysfunction-Associated Steatotic Liver Disease Across the Cardiovascular-Kidney-Metabolic Spectrum: Insights from the CARDIA Study2026
  2. 2Relationship between metabolic dysfunction-associated steatotic liver disease and cardiovascular mortality risk in individuals with CKM stages 0-2: Mediating roles of inflammation and insulin resistance.2026
  3. 3Stratified Burden of MASLD in Cardiovascular-Kidney-Metabolic syndrome: Stage-Dependent Prevalence and Insulin Resistance-Driven Cardiovascular Mortality2025 · 1 citations
  4. 4Cardiovascular-kidney-metabolic progression associated with major adverse liver outcomes: mediating roles of plasma metabolites2025 · 6 citations
  5. 5MASLD and Cardiovascular Risk: Mechanisms and Implications for Clinical Practice2026