Prognosis
Natural history of metabolic dysfunction-associated steatotic liver disease (MASLD)
A prospective cohort study observed 1773 adults with MASLD for a median of 4 years. Mortality in the study population was higher than the expected age-related background rates. Mortality increased as the fibrosis stage increased. Patients with stage F4 fibrosis had significantly higher all-cause mortality (hazard ratio [HR] 3.9, 95% CI 1.8 to 8.4) and liver-related mortality (HR 12.7, 95% CI 1.8 to 88.6), compared with patients with stage F0 to F2 fibrosis. Any hepatic decompensation event was associated with an almost 7-fold increased risk of mortality. The most common decompensation events were encephalopathy and ascites.[16]
The risk of MASL progressing to cirrhosis or liver failure is minimal.[3]
One study of patients with metabolic dysfunction-associated steatohepatitis (MASH) who had undergone serial liver biopsies found that fibrosis stage progressed in 37%, remained stable in 34%, and regressed in 29%.[151] Independent predictors of fibrosis progression included diabetes mellitus, a low initial fibrosis stage, and a higher body mass index. At a mean follow-up of 14 years, MASH is associated with increased overall mortality, which was primarily a result of cardiovascular disease and to a lesser extent liver-related causes.[151] In one longitudinal study of patients with fatty liver, fibrosis stage (but no other histological feature) was associated with long-term outcomes.[152]
Patients who have MASH progress to cirrhosis 9% to 20% of the time. Up to one third of these patients will die from complications from liver failure or require liver transplantation.[153] With the epidemic number of individuals with MASLD, end-stage liver disease secondary to MASH cirrhosis is becoming a leading indication for liver transplantation.[116]
Recurrent MASLD following liver transplantation is a well-recognised phenomenon. The incidence of the development of post-liver transplantation steatosis ranges anywhere from 25% to 100%, and the incidence of MASH ranges from a low of 10% to as high as 37.5%.[154]
Although recurrent MASH following liver transplantation is common, the development of allograft cirrhosis is rare, reported at less than 2% in one cohort study of more than 200 patients with a mean follow-up of 7 years.[155]
Concurrent hepatitis C
Hepatic steatosis affects up to 80% of patients with chronic hepatitis C infection. Concurrent fatty liver disease with hepatitis C includes increased disease progression, elevated risk of primary liver cancer, and a decreased response to antiviral therapy.[156]
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