Cause-specific mortality in patients with steatotic liver disease in the United States

作者：Pedro Ochoa‐Allemant, Rebecca A. Hubbard, David Kaplan, Marina Serper · 发表于：Journal of Hepatology · 年份：2025 · DOI：10.1016/j.jhep.2025.05.013 · 被引用次数：45 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Alcohol Consumption and Health Effects

BACKGROUND & AIMS: Causes of death across steatotic liver disease (SLD) subtypes remain incompletely characterized in routine clinical practice. We aimed to quantify and compare cause-specific mortality in patients with SLD. METHODS: We conducted a retrospective cohort study of adults with imaging-confirmed hepatic steatosis receiving outpatient care in the national Veterans Health Administration (2010-2021). The primary exposure was SLD subtype, including metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and their intersection (MetALD). The primary outcome was cause-specific mortality, stratified by baseline cirrhosis. RESULTS: Among 366,433 adults (mean age, 60.5 years; 7.7% female; 67.6% non-Hispanic White), 77.9% had MASLD, 17.5% had MetALD, and 4.6% had ALD. Over a median follow-up of 5.4 years, the 10-year cumulative incidences of cardiovascular disease (CVD)- and extrahepatic cancer-related deaths among patients without cirrhosis were 8.1% and 7.5% for MASLD, 7.5% and 7.4% for MetALD, and 8.1% and 7.4% for ALD. Among patients with cirrhosis, the 10-year cumulative incidences of liver- and CVD-related deaths were 9.2% and 17.3% for MASLD, 17.7% and 13.0% for MetALD, and 22.1% and 11.5% for ALD. Compared with non-cirrhotic MASLD (0.04 per 100 person-years), liver-related mortality was higher for MetALD (0.19 per 100 person-years; hazard ratio 3.38; 95% CI 3.02-3.78) and highest for ALD (0.40 per 100 person-years; ha...