2025-03-24 カロリンスカ研究所(KI)
<関連情報>
- https://news.ki.se/fatty-liver-linked-to-increased-risk-of-death-from-several-diseases
- https://www.journal-of-hepatology.eu/article/S0168-8278(25)00156-4/fulltext
スウェーデンにおける代謝機能障害関連脂肪性肝疾患患者13,099例における原因別死亡率 Cause-specific mortality in 13,099 patients with metabolic dysfunction-associated steatotic liver disease in Sweden
Gabriel Issa ∙ Ying Shang ∙ Rickard Strandberg ∙ Hannes Hagström ∙ Axel Wester
Journal of Hepatology Published:March 24, 2025
DOI:https://doi.org/10.1016/j.jhep.2025.03.001
Graphical abstract
Highlights
- All-cause mortality rate was nearly doubled in MASLD versus the general population
- Liver- and hepatocellular carcinoma (HCC) mortality were highest in relative terms
- Non-HCC cancer and cardiovascular disease mortality were highest in absolute terms
- Earlier multidisciplinary care might be needed to reduce premature mortality
Abstract
Background and aims
Data on cause-specific mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) are limited. We aimed to determine the rate and risk of death from different causes in patients with MASLD compared to the general population in Sweden.
Methods
In this population-based cohort study, we identified individuals with an ICD-10 code for MASLD in inpatient or specialized outpatient care using Swedish healthcare registers 2002-2020 (n=13,099) and matched them with up to 10 controls (median 9) from the general population for age, sex, municipality, and calendar year (n=118,884). We used Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for eleven different primary causes of death. 15-year cumulative incidences of death were calculated while accounting for competing risks.
Results
In total, 1,628 (12.4%) deaths occurred in patients with MASLD and 9,119 (7.7%) in controls during a median follow-up of 4.7 (interquartile range [IQR] 2.0-9.2) and 5.8 years (IQR 2.7-10.5), respectively. MASLD was associated with higher all-cause mortality (HR=1.85, 95%CI=1.74-1.96) and higher rates of all specific causes of death except mental health disorder. The strongest associations were observed for non-hepatocellular carcinoma (HCC) liver-related (HR=26.9, 95%CI=19.4-37.3) and HCC-related mortality (HR=35.0, 95%CI=17.0-72.1). However, the highest estimated 15-year cumulative incidence of death in patients with MASLD was for non-HCC cancer (7.3%) and cardiovascular disease (7.2%).
Conclusions
MASLD was strongly associated with liver- and HCC-related mortality, but the absolute risks of death were highest for non-HCC cancer and cardiovascular disease. Mortality was increased for nearly all causes in patients with MASLD, suggesting that earlier multidisciplinary care is needed to reduce excess mortality.
Impact and implications
Previous studies on mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) were either small, restricted to liver-related mortality, relying on liver biopsy to identify patients and thus inducing selection bias, or mainly using data from old cohorts. In a nationwide cohort study of all patients diagnosed with MASLD in inpatient or specialized outpatient care in Sweden between 2002 and 2020, we found a nearly doubled all-cause mortality rate and higher mortality than the general population from a wide range of causes, indicating that earlier multidisciplinary care may be needed to reduce premature mortality in patients with MASLD. The absolute risk estimates of death in our study may be useful for clinicians and policymakers to inform patients about their prognosis and potentially implement clinical or public health strategies to reduce premature mortality.
