METABOLIC dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is now the most prevalent chronic liver disease in the USA driving the demand for liver transplants. MASLD’s increasing rates – projected to reach 100.9 million cases by 2030 – are largely tied to rising metabolic conditions like obesity and type 2 diabetes. Currently, MASLD contributes to a $103 billion economic burden in direct medical costs annually in the U.S.
Liver biopsy remains the preferred diagnostic method for MASLD, essential for grading its severity and determining the presence of metabolic dysfunction-associated steatohepatitis (MASH), a progression often associated with fibrosis. Fibrosis stage, particularly advanced stages, is closely linked to increased mortality risks and severe liver-related events, including hepatocellular carcinoma and liver decompensation. This U.S.-based study examined the influence of clinical and histologic risk factors on long-term MASLD outcomes in patients confirmed via liver biopsy.
The study’s results identified advanced fibrosis as a major predictor of liver-related complications, with stage 3 fibrosis patients facing a 2.68 times higher risk, and stage 4 fibrosis patients facing a 6.96 times higher risk of these outcomes. Stage 4 fibrosis was especially concerning, linked to a significantly elevated rate of liver decompensation events (8.46 times higher). Hypertension also emerged as a predictor of liver decompensation, underscoring its relevance in patient stratification.
The findings reinforce fibrosis stage as a core marker for clinical decision-making, guiding MASH-specific therapy and prioritising high-risk patients for lifestyle and pharmacological interventions. Although non-invasive fibrosis assessments are gaining popularity, liver biopsy remains crucial for accuracy, particularly given the architectural changes and portal hypertension risks linked to advanced fibrosis stages.
While this study was limited by follow-up duration and a predominantly White cohort, its emphasis on biopsy-proven MASLD strengthens the predictive role of fibrosis staging in patient management, supporting clinical pathways that could ultimately improve MASLD outcomes.
Reference
Lam R et al. Advanced liver fibrosis predicts liver outcomes in biopsy-proven metabolic dysfunction-associated steatotic liver disease: a U.S.-based single-center retrospective cohort study. J Clin Transl Hepatol. 2024;DOI:10.14218/JCTH.2024.00189.
