Liver Histology Impact on Long-Term Clinical Outcomes in MASH

Fibrosis stage, lobular inflammation, and hepatocyte ballooning grades emerged as key predictors of long-term outcomes among patients with metabolic-associated steatohepatitis (MASH), researchers reported in Hepatology Communications.

The study followed 702 adults from Vanderbilt University Medical Center who had evidence of MASH on liver biopsy, over a median of 4.7 years to assess the risks of cirrhosis, other noncirrhotic liver-related and cardiovascular outcomes, and mortality due to liver, cardiovascular, or cancer-related events. Histological features such as fibrosis stage, lobular inflammation, hepatocyte ballooning, and steatosis score were evaluated as predictors of clinical outcomes, adjusting for factors like age, sex, diabetes, and weight-loss surgery.

Results showed that a lower fibrosis stage (F0–1) was associated with a significantly reduced risk of cirrhosis (HR: 0.22 vs. F3) and liver-related outcomes compared to patients with advanced fibrosis (F4). Additionally, lower lobular inflammation (LI1) and hepatocyte ballooning grades (HB1) were linked to lower cirrhosis risk. In patients with weight-loss surgery, lower lobular inflammation was also associated with reduced liver-related risks.

While fibrosis stage strongly predicted long-term liver outcomes, the other histological features (inflammation, ballooning, and steatosis) did not show significant differences in noncirrhotic or cardiovascular outcomes.

These findings highlight the importance of using these histological markers as potential surrogates for disease progression and clinical outcome prediction, the authors concluded.

Reference
Younossi ZM, Mangla KK, Berentzen TL, et al. Liver histology is associated with long-term clinical outcomes in patients with metabolic dysfunction-associated steatohepatitis. Hepatol Commun. Published online ahead of print May 10, 2024. doi:10.1097/HC9.0000000000000423