The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis

期刊论文
出版模式：

开放获取
发表日期：

2024年4月15日

查看全文

Javier Ampuero,
Rocío Aller,
Rocío Gallego-Durán,
Javier Crespo,
Jose Luis Calleja,
Carmelo García-Monzón,
Judith Gómez-Camarero,
Joan Caballería,
Oreste Lo Iacono,
Luis Ibañez,
Javier García-Samaniego,
Agustín Albillos,
Rubén Francés,
Conrado Fernández-Rodríguez,
Douglas Maya-Miles,
Moisés Diago,
Maria Poca,
Raúl J. Andrade,
Raquel Latorre,
Francisco Jorquera,
Rosa María Morillas,
Desamparados Escudero,
Manuel Hernández-Guerra,
María Jesús Pareja-Megia,
Jesús M. Banales,
Patricia Aspichueta,
Salvador Benlloch,
José Miguel Rosales,
Juan Turnes,
Manuel Romero-Gómez

摘要

Background

MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern.

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.