Serum ferritin levels can predict long-term outcomes in patients with metabolic dysfunction-associated steatotic liver disease.
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Armandi Angelo, Sanavia Tiziana, Younes Ramy, Caviglia Gian Paolo, Rosso Chiara, Govaere Olivier, Liguori Antonio, Francione Paolo, Gallego-Duràn Rocìo, Ampuero Javier, Pennisi Grazia, Aller Rocio, Tiniakos Dina, Burt Alastair, David Ezio, Vecchio Fabio, Maggioni Marco, Cabibi Daniela, McLeod Duncan, Pareja Maria Jesus, Zaki Marco Y W, Grieco Antonio, Stål Per, Kechagias Stergios, Fracanzani Anna Ludovica, Valenti Luca, Miele Luca, Fariselli Piero, Eslam Mohammed, Petta Salvatore, Hagström Hannes, George Jacob, Schattenberg Jörn M, Romero-Gómez Manuel, Anstee Quentin Mark, Bugianesi Elisabetta
Аннотация
DESIGN: We evaluated the relationship between baseline serum ferritin and longitudinal events in a multicentre cohort of 1342 patients. Four survival models considering ferritin with confounders or non-invasive scoring systems were applied with repeated five-fold cross-validation schema. Prediction performance was evaluated in terms of Harrell's C-index and its improvement by including ferritin as a covariate.
RESULTS: Median follow-up time was 96 months. Liver-related events occurred in 7.7%, hepatocellular carcinoma in 1.9%, cardiovascular events in 10.9%, extrahepatic cancers in 8.3% and all-cause mortality in 5.8%. Hyperferritinaemia was associated with a 50% increased risk of liver-related events and 27% of all-cause mortality. A stepwise increase in baseline ferritin thresholds was associated with a statistical increase in C-index, ranging between 0.02 (lasso-penalised Cox regression) and 0.03 (ridge-penalised Cox regression); the risk of developing liver-related events mainly increased from threshold 215.5 µg/L (median HR=1.71 and C-index=0.71) and the risk of overall mortality from threshold 272 µg/L (median HR=1.49 and C-index=0.70). The inclusion of serum ferritin thresholds (215.5 µg/L and 272 µg/L) in predictive models increased the performance of Fibrosis-4 and Non-Alcoholic Fatty Liver Disease Fibrosis Score in the longitudinal risk assessment of liver-related events (C-indices>0.71) and overall mortality (C-indices>0.65).
CONCLUSIONS: This study supports the potential use of serum ferritin values for predicting the long-term prognosis of patients with MASLD.