The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis.
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Ampuero Javier, Aller Rocío, Gallego-Durán Rocío, Crespo Javier, Calleja Jose Luis, García-Monzón Carmelo, Gómez-Camarero Judith, Caballería Joan, Lo Iacono Oreste, Ibañez Luis, García-Samaniego Javier, Albillos Agustín, Francés Rubén, Fernández-Rodríguez Conrado, Maya-Miles Douglas, Diago Moisés, Poca Maria, Andrade Raúl J, Latorre Raquel, Jorquera Francisco, Morillas Rosa María, Escudero Desamparados, Hernández-Guerra Manuel, Pareja-Megia María Jesús, Banales Jesús M, Aspichueta Patricia, Benlloch Salvador, Rosales José Miguel, Turnes Juan, Romero-Gómez Manuel, HEPAmet Registry
Аннотация
OBJECTIVE: To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis.
METHODS: Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H), > 5; (b) mixed pattern(M),2-5; (c) cholestatic pattern(C), < 2.
OUTCOMES: (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death.
RESULTS: Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H vs. 41.9% M vs. 31.9% C) were more common in H-pattern (p = 0.0001),whilst C-pattern was linked to cirrhosis (5.8% H vs. 5.6% M vs. 10.9% C; p = 0.0001). FIB-4(0.74(95% CI 0.69-0.79) vs. 0.83 (95% CI 0.80-0.85); p = 0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69-0.85) vs. 0.84 (95% CI 0.80-0.87); p = 0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12-5.02); p = 0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation.
CONCLUSIONS: The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.