Trajectory of compensated metabolic dysfunction-associated steatohepatitis in a tertiary center with a large hispanic/latino population

Abstract Metabolic dysfunction-associated steatohepatitis (MASH) is increasingly being recognized as a major cause of chronic liver disease and liver transplantation worldwide. Despite emerging therapies, compensated MASH cirrhosis often remains underdiagnosed and undertreated. This study aimed to characterize disease progression and examine the risk factors. We identified patients with compensated MASH cirrhosis at the University of California, San Francisco (2012-2024), and extracted baseline characteristics. We modeled mortality, hepatic decompensation, and disease progression using penalized Cox regression and performed subgroup analyses comparing Latino/Hispanic and non-Hispanic/Latino patients. The study cohort consisted of 493 patients, with a median follow-up time of 3.4 years. Their median age was 56.1 years, and 33.9% were Hispanic/Latino. During the study period, 32.5% of the cohort had at least one MASH-related outcome, with 5-year mortality and decompensation rates of 14.2% and 19.9%, respectively. In the multivariable time-to-event analysis, higher MELD and FIB-4 scores were key predictors of MASH progression. Hispanic/Latino patients presented with higher median MELD scores and lower socioeconomic conditions, resulting in worse unadjusted outcomes than non-Hispanic/Latino patients. After adjusting for these variables, most outcome disparities were attenuated. These findings underscore the importance of early diagnosis, risk stratification, and targeted interventions to enhance outcomes, particularly among underserved populations.