[Proportion and clinical characteristics of probable metabolic-associated fatty liver disease-related cirrhosis in cryptogenic cirrhosis].

Objective: To explore the likelihood of metabolic-associated fatty liver disease (MAFLD)based on metabolic characteristics and to provide a reference for identifying potential causative factors in patients with cryptogenic cirrhosis. Methods: A total of 2,190 patients with cirrhosis admitted to the Department of Hepatology, Beijing Friendship Hospital, Capital Medical University, from January 2022 to December 2024 were retrospectively analyzed. 163 patients with cryptogenic cirrhosis following screening by exclusion criteria were finally included. According to the Liver Forum consensus, patients were classified into three groups based on metabolic characteristics: "very likely" MAFLD-related cirrhosis, "possibly" MAFLD-related cirrhosis, and "other" cryptogenic cirrhosis. 151 patients with MAFLD-related cirrhosis served as the control group and were admitted during the same period. Clinical data and prognostic scores were collected and compared among the groups. Logistic regression analysis was used to assess the impact of MAFLD as a potential etiology for prognostic score categories. Normally distributed continuous variables were compared using one-way ANOVA, while non-normally distributed continuous variables were compared using non-parametric tests for overall intergroup analysis. Categorical variables were analyzed using chi-square tests or Fisher's exact tests. Post-hoc pairwise comparisons were conducted when the overall differences were statistically significant. Multiple comparisons were performed for type 1 error control. The Bonferroni correction method was applied to control for type I error in multiple comparisons and p-values. Results: Among 163 patients with cryptogenic cirrhosis, 57(35.0%) were "very likely" MAFLD-related cirrhosis, and 31(19.0%) were "possibly" MAFLD-related cirrhosis, both groups totaling 88(54.0%). Compared with the definitive diagnosis group, the "very likely" and "possibly" groups showed no statistically significant differences in the prevalence rate of overweight/obesity (86.4% vs. 90.7%), type 2 diabetes mellitus (53.4% vs. 59.6%), and hyperlipidemia (10.2% vs. 20.5%) (adjusted P>0.05), with only a lower prevalence of hypertension (40.9% vs. 56.3%, adjusted P=0.044). However, the former group exhibited significantly lower lipid levels at presentation (adjusted P<0.05), with no significant difference in fasting blood glucose levels (adjusted P=1.000). Additionally, a higher proportion of patients were in decompensated stages (81.8% vs. 60.9%, adjusted P=0.002), with worse liver function and higher risks of adverse prognosis. Conclusion: Metabolic factors were associated with more than half of the cases of cryptogenic cirrhosis at our hospital. However, lipid and blood glucose abnormalities at the time of consultation were often unremarkable, as these patients had already progressed to the decompensated stage. Therefore, the assessment of current and past metabolic factors should be prioritized for patients with cryptogenic cirrhosis in clinical practice.