Long‐term clinical outcomes in steatotic liver disease and incidence of liver‐related events, cardiovascular events and all‐cause mortality

Summary Background A multi‐society consensus group proposed a new nomenclature for steatotic liver disease (SLD) including metabolic‐dysfunction associated steatotic liver disease (MASLD), MASLD and increased alcohol intake (MetALD) and alcohol‐associated liver disease (ALD). However, the risk of liver‐related events, major adverse cardiovascular events (MACE) and all‐cause mortality among various sub‐groups is unknown. Aims To evaluate the risk of liver‐related events, MACE and death among patients with SLD. Methods We conducted a nationwide, population‐based study and enrolled 761,400 patients diagnosed with MASLD, MetALD or ALD. The primary endpoint was the occurrence of liver‐related events, MACE and death in patients with MASLD, MetALD and ALD. Results The cumulative incidence of liver‐related events and death were highest in ALD, followed by MetALD and MASLD ( p < 0.001 for both liver‐related events and death), while the incidence of MACE was highest in MASLD, followed by MetALD and ALD ( p < 0.001). Using MASLD as the reference and adjusting for age, sex, smoking, diabetes mellitus, dyslipidaemia and hypertension, the adjusted hazard ratios (95% confidence intervals) for liver‐related events, MACE and death in MetALD were 1.42 (1.1–1.8), 0.68 (0.63–0.73) and 1.13 (0.98–1.3), respectively. In ALD, they were 3.42 (2.6–4.6), 0.58 (0.49–0.67) and 1.60 (1.3–2.0), respectively, for liver‐related events, MACE and death. Conclusions The new consensus nomenclature can be used to stratify the risk of complications and prognosis. The nomenclature is beneficial for risk stratification and identifying new mechanisms for disease‐specific therapeutic implications.