Cardiovascular–kidney–metabolic syndrome and the risk of liver fibrosis progression and liver-related events in MASLD

作者：Xiaodong Zhou, Qin‐Fen Chen, Qi Fan, Seung Up Kim, Terry Cheuk‐Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah‐Kheong Chan, Manuel Romero‐Gómez, José Luís Calleja, Victor de Lédinghen, Laurent Castéra, Arun J. Sanyal, George Boon‐Bee Goh, Philip N. Newsome, Jian-Gao Fan, Michelle Lai, Céline Fournier‐Poizat, Hye Won Lee, Grace Lai‐Hung Wong, Angelo Armandi, Ying Shang, Grazia Pennisi, Elba Llop, Masato Yoneda, Marc de Saint-Loup, Clémence M. Canivet, Paloma Carrillo, Carmen Lara‐Romero, Rocío Gallego‐Durán, Amon Asgharpour, Kevin Kim‐Jun Teh, Mandy Sau-Wai Chan, Huapeng Lin, Wen‐Yue Liu, Giovanni Targher, Christopher D. Byrne, Vincent Wai‐Sun Wong, Ming‐Hua Zheng, on behalf of the VCTE-Prognosis Study Group · 发表于：Hepatology · 年份：2025 · DOI：10.1097/hep.0000000000001645 · 被引用次数：16 · 研究领域：Liver Disease Diagnosis and Treatment、Parathyroid Disorders and Treatments、Liver Disease and Transplantation

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome, a new framework integrating cardiovascular, renal, and metabolic dysfunction, remains inadequately characterized in metabolic dysfunction-associated steatotic liver disease (MASLD). OBJECTIVE: We investigated the relationships between CKM stages and liver fibrosis severity, progression, and the risk of liver-related events (LREs) in MASLD. DESIGN: Patients with MASLD from the VCTE-Prognosis cohort were stratified according to CKM stages. Outcomes included the prevalence of advanced liver fibrosis (LSM ≥10 kPa), liver stiffness progression (≥20% increase and Baveno category upshift), and incident LREs. Associations were assessed using multivariable logistic regression and Cox proportional hazards models. RESULTS: Among 12,097 patients with MASLD, the prevalence of advanced liver fibrosis increased across CKM stages at baseline: 9.6% (CKM stage 0-1), 18.0% (CKM stage 2), and 31.6% (CKM stage 3-4). CKM stage 2 (adjusted OR=1.663, 95% CI 1.444-1.915) and CKM stage 3-4 (adjusted OR=2.575, 95% CI 2.109-3.144) were independently associated with advanced fibrosis. During a 4.5-year median follow-up, 716 patients (6.1%) experienced progression of liver stiffness, and 352 patients (1.7%) developed LRE. Compared with CKM stage 0-1, the risk of liver stiffness progression was higher in CKM stage 2 (adjusted HR=1.321, 95% CI 1.050-1.662; p =0.018) and CKM stage 3-4 (adjusted HR=1.767, 95% CI 1.339-2.330; p <0.001). In contrast, o...