Risk of liver and cardiovascular outcomes in patients with metabolic dysfunction-associated steatohepatitis (MASH): a retrospective cohort study

OBJECTIVE: Metabolic dysfunction-associated steatohepatitis (MASH) is a chronic liver condition linked to hepatic and extra-hepatic complications. This study aimed to estimate the risk of developing major adverse liver outcomes (MALO) and major adverse cardiovascular events (MACE) among patients with MASH. METHODS: This retrospective cohort study used deidentified data from the Optum Clinformatics Data Mart Database to compare MALO (i.e. cirrhosis or associated complications, hepatocellular carcinoma, and liver transplant), modified 3-point MACE (i.e. nonfatal acute myocardial infarction (AMI), nonfatal stroke, and all-cause mortality), and expanded MACE (i.e. nonfatal AMI, nonfatal stroke, unstable angina (UA), coronary revascularization, or heart failure (HF) hospitalization) among adult patients newly diagnosed with MASH vs. patients without MASH. The risks of MALO, modified 3-point, and expanded MACE were estimated using descriptive methods (cumulative incidence and Kaplan-Meier estimator). Multivariable methods (Fine-Gray and Cox proportional hazards models) were used to describe the adjusted risk of 3-point MACE and MALO. RESULTS: MALO and MACE were assessed in 26,301 and 32,108 pairs of patients, respectively, in the matched cohorts with MASH and without MASH. After adjusting for baseline confounders, the risks for MALO (subdistribution hazard ratio, 6.78; 95% CI, 6.27-7.34) and modified 3-point MACE (hazard ratio, 1.67; 95% CI, 1.57-1.78) were significantly higher among patients with MASH vs. those without MASH. CONCLUSION: MASH was associated with significantly higher risks of MALO and MACE. This highlights the clinical burden of MASH and the need for early detection and management.