Association of metabolic vulnerability index with various chronic liver diseases and mortality: a large prospective cohort study

BACKGROUND: The association between metabolic vulnerability index (MVX), a composite biomarker integrating inflammatory and metabolic pathways, and chronic liver diseases (CLDs) is still unclear. METHODS: This prospective cohort study included 255,171 participants from the UK Biobank, with a median follow-up period of 13.71 years. Multivariable-adjusted cox proportional hazards models, restricted cubic splines (RCS) and sensitivity analyses were used to evaluate the association between MVX and CLDs. RESULTS: This study showed that higher levels of MVX (Q4 vs Q1) significantly increased the risk of CLDs after adjusted by socio-demographic and health status factors (all P < 0.05): cirrhosis (HR = 1.60, 95%CI:1.38-1.86), alcoholic-related liver disease (HR = 1.34, 95%CI:1.07-1.68), autoimmune liver disease (HR = 1.35, 95%CI:1.12-1.62), liver and biliary tract cancer (HR = 1.32, 95%CI:1.05-1.66), liver disease-related death (HR = 2.11, 95%CI:1.59-2.80), and all-cause mortality (HR = 1.17, 95%CI:1.13-1.21). No association was found between MVX and viral hepatitis. RCS and threshold analysis showed a reverse L-shaped association between MVX and cirrhosis and liver-related deaths, a linearly increasing association with AILD and LBC, and a J-shaped association with ALD and all-cause mortality. Subgroups analysis and sensitivity analyses demonstrated stable correlation between MVX and CLDs and death events. CONCLUSION: MVX is a promising indicator for independently predicting CLD events, liver-related mortality, and all-cause mortality. As a marker of metabolic-inflammatory dysregulation, MVX may enable early identification of high-risk individuals for targeted primary prevention of CLDs.