The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis

Background: MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern. Objective: To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in h...

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Detalles Bibliográficos
Autores: Ampuero, Javier, Aller, Rocío, Crespo García, Javier, Calleja, José Luis, García-Monzón, Carmelo, Gómez-Camarero, Judith, Caballería, Joan, Lo Iacono, Oreste, Ibáñez, Luis, García-Samaniego, Javier, Albillos, Agustín, Francés, Rubén, Fernández-Rodríguez, Conrado, Maya-Miles, Douglas, Diago, Moisés, Poca, María, Andrade, Raúl J., Latorre, Raquel, Jorquera, Francisco, Morillas, Rosa María
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/33032
Acceso en línea:https://hdl.handle.net/10902/33032
Access Level:acceso abierto
Palabra clave:Hepatocellular
Cholestasis
MASLD
Phenotypes
Transaminases
Descripción
Sumario:Background: MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern. Objective: To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis. Methods: Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H),>5; (b) mixed pattern(M),2-5; (c) cholestatic pattern(C),<2. Outcomes: (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death. Results: Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H vs. 41.9% M vs. 31.9% C) were more common in H-pattern (p=0.0001),whilst C-pattern was linked to cirrhosis (5.8% H vs. 5.6% M vs. 10.9% C; p=0.0001). FIB-4(0.74(95% CI 0.69-0.79) vs. 0.83 (95% CI 0.80-0.85); p=0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69-0.85) vs. 0.84 (95% CI 0.80-0.87); p=0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12-5.02); p=0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation. Conclusions: The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.

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