Impact of first and further decompensation in patients with compensated ACLD due to MASLD

In this large international multicenter cohort of 6,061 patients with compensated advanced chronic liver disease (cACLD) due to metabolic dysfunction-associated steatotic liver disease (MASLD), we examined the clinical impact of first and further decompensation events. At 5 years, the cumulative incidences of first and further decompensation were 3.5% and 43.9%, respectively, each significantly increasing the cause-specific hazard of liver-related death (18.9-fold and 1.52-fold). Ascites, more so than variceal bleeding, was the predominant and most impactful event. Both acute and non-acute decompensation similarly contributed to liver-related mortality. Additionally, hepatocellular carcinoma independently increased the hazard of liver-related death, even post-decompensation. Notably, extrahepatic deaths also represented a considerable burden, reflecting the high metabolic risk of MASLD. These findings highlight key prognostic inflection points in MASLD-related cACLD.

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Publication Details

Journal
Journal of Hepatology
Published
2025-06-21
DOI
https://doi.org/10.1016/j.jhep.2025.06.014
Citations
2
Primary Topic
Liver Disease and Transplantation
Type
article
Field-Weighted Citation Impact
2.64

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article

Impact of first and further decompensation in patients with compensated ACLD due to MASLD

Stergios Kechagias, Jacob George, Calogero Cammà, Adele Tulone et al.
2 citations
Journal of Hepatology
Liver Disease and Transplantation
2.64
article

Impact of first and further decompensation in patients with compensated ACLD due to MASLD

Stergios Kechagias, Jacob George, Calogero Cammà, Adele Tulone, Vincenza Calvaruso, Gianluca Svegliati‐Baroni, Anna Ludovica Fracanzani, Mario Masarone, Mattias Ekstedt, Elisabetta Bugianesi, Marcello Persico, Patrik Nasr, V. Di Marco, Victor de Lédinghen, Filippo Schepis, Luca Valenti, Annalisa Berzigotti, Roberta D’Ambrosio, Angelo Armandi, Giuseppe Infantino, Yuly P. Mendoza, Alessio Aghemo, Antonio Liguori, Dario Saltini, Salvatore Petta, Grazia Pennisi, Fabio Marra, Gabriele Di Maria, Federico Ravaioli, Marco Enea, Nicola Riccardo Pugliese, Luca Miele, Giada Sebastiani, Vincent Wai‐Sun Wong, Huapeng Lin, Mauro Viganò
article en
2 citations

Abstract

In this large international multicenter cohort of 6,061 patients with compensated advanced chronic liver disease (cACLD) due to metabolic dysfunction-associated steatotic liver disease (MASLD), we examined the clinical impact of first and further decompensation events. At 5 years, the cumulative incidences of first and further decompensation were 3.5% and 43.9%, respectively, each significantly increasing the cause-specific hazard of liver-related death (18.9-fold and 1.52-fold). Ascites, more so than variceal bleeding, was the predominant and most impactful event. Both acute and non-acute decompensation similarly contributed to liver-related mortality. Additionally, hepatocellular carcinoma independently increased the hazard of liver-related death, even post-decompensation. Notably, extrahepatic deaths also represented a considerable burden, reflecting the high metabolic risk of MASLD. These findings highlight key prognostic inflection points in MASLD-related cACLD.

Journal of HepatologyVol. 83(6)
Linköping University (SE), University of Bern (CH), University of Modena and Reggio Emilia (IT), Marche Polytechnic University (IT), The University of Sydney (AU), University of Salerno (IT), Humanitas University (IT), Inserm (FR), Chinese University of Hong Kong (HK), University of Milan (IT), University Hospital of Bern (CH), McGill University Health Centre (CA), Agostino Gemelli University Polyclinic (IT), Westmead Hospital (AU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Ospedale Maggiore (IT), Azienda Unita' Sanitaria Locale Di Modena (IT), Azienda Ospedaliero-Universitaria di Modena (IT), Azienda USL di Bologna (IT), Hôpital Cardiologique du Haut-Lévêque (FR), Westmead Institute (AU), Westmead Institute for Medical Research (AU), Ospedale San Giuseppe (IT), IRCCS Humanitas Research Hospital (IT), University of Florence (IT), University of Turin (IT), University of Palermo (IT), University of Bologna (IT)
Pfizer, Gilead Sciences
Openalex Percentile: Top 10%
Liver Disease and Transplantation
2.64
DOIOpen Access PDFOpenAlex
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