Hepatic Steatosis Estimated by VCTE-Derived CAP Scores Was Associated With Lower Risks of Liver-Related Events and All-Cause Mortality in Patients With Chronic Liver Diseases

INTRODUCTION: The controlled attenuated parameter (CAP) score derived from vibration-controlled transient elastography (VCTE, i.e., FibroScan) is a well-validated marker of hepatic steatosis. It is unclear whether CAP scores are associated with risks of liver-related outcomes or all-cause mortality. METHODS: In this retrospective cohort study, we identified 7,587 United States veterans (2,689 with cured hepatitis C [hepatitis C virus], 1,523 with alcohol-associated liver disease, and 3,375 with metabolic dysfunction-associated steatotic liver disease [MASLD]) who underwent VCTE between May 2015 and December 2021. We followed patients for new hepatic decompensation, hepatocellular carcinoma, and death from the VCTE date until January 1, 2022. Multivariable Cox-proportional hazards regression was used to assess for the associations between CAP measurements and clinical outcomes, adjusting for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, diabetes, liver disease etiology, liver stiffness measurements, and Fibrosis-4 score, and was reported separately by disease etiology and advanced fibrosis status. RESULTS: Over a median follow-up time of ∼1.9 years, hepatic steatosis (grades 1–3 vs 0) was associated with a lower risk of death (adjusted hazard ratio [aHR] 0.70, 95% CI: 0.57–0.85). Among patients with MASLD, hepatic steatosis was associated with a lower risk of decompensation (aHR 0.54, 95% CI: 0.32–0.90) and death (aHR 0.52, 95% CI: 0.37–0.73). These associations persisted in subgroup analyses of patients with advanced fibrosis and without cirrhosis. DISCUSSION: Among patients who underwent VCTE in clinical practice, the presence of substantial hepatic steatosis estimated by the CAP score was associated with lower all-cause mortality among all patients and lower risk of decompensation and death among those with MASLD.