Introduction
To reduce mortality risks in patients with metabolic dysfunction-associated steatohepatitis (MASH) it is critical to have a better disease understanding in real-world populations. Limitations of past studies were small sample size, point in time of data collection, being single center, biopsy based, or broad focus on steatotic liver disease.
Aims & Methods
This study investigates mortality rates, causes of death, and the role of socio-demographic risk factors and biomarkers that could be associated with mortality in a large real-world MASH population.
Retrospective cohort study (2016-2021 years) using Optum Market Clarity (linked claims and electronic health records, EHRs) from the United States. MASH was defined by the first ICD10 diagnosis code (K75.81 Nonalcoholic steatohepatitis) recorded during the study period, presence of AST, ALT and platelets tests carried out 3 months prior/after diagnosis, and absence of diseases prior/at diagnosis, such as alcoholic/chronic liver diseases. Risk factors included age, sex, race, region, comorbidities, FIB-4 fibrosis score and routinely collected biomarkers such as LDL cholesterol, Triglycerides, eGFR, and HbA1c. The associations between risk factors and mortality were estimated using multivariate survival models. To contextualize findings, crude mortality rates were calculated in the subgroup of MASH patients with BMI ≥ 25 and type 2 diabetes (T2D) and in a group of patients in Optum with BMI ≥ 25 who did not report any liver diseases or T2D.
Results
18,710 MASH patients (mean age 44 years, 54% female, 80% white, 95% with BMI ≥ 25, 52% with T2D) had been followed-up (FU) for 6.5 years after diagnosis (mean FU = 3 years): 1465 patients died (70% from cardiovascular disease (CVD) and 17% from liver-related causes). The mortality rate was 25 per 1000 persons-year (py). African Americans (vs white) and South residents (vs North-East) had higher all-cause mortality rates [Hazard ratios (HRs) of 1.33 and 1.45 respectively]. A decrease in eGFR of 10 mL/min/1.73m² and having 3 or more comorbidities (vs none) were also associated with increased mortality (HRs of 1.21 and 1.93 respectively). The mortality rate was 31 per 1000 py in MASH with BMI ≥ 25 and T2D (5 times higher than those with BMI ≥ 25 without liver diseases/diabetes).
Conclusion
CVD risk reduction in patients with MASH will be crucial to improve outcomes. Mortality rates are especially high in MASH patients who are overweight/obese and living with T2D. In addition, racial differences in MASH mortality were observed: African Americans and South residents were at increased risk; this may be due to less access to health care. Also, the eGFR-mortality association signaled that kidney and renal disease prevention is important. This is the largest and most comprehensive study on MASH mortality using claims and EHRs.
Disclosure
Originally presented at International Liver Congress 2024, organized by the European Association for the Study of the Liver (EASL)