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Temporal comorbidity patterns preceding MASLD-related major adverse liver outcomes: a nationwide population-based
Joost Boeckmans1,2, Linnea Widman1, Rickard Strandberg1
1Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Background:
The patterns of comorbidities preceding major adverse liver outcomes (MALOs) in metabolic dysfunction-associated steatotic liver disease (MASLD) are unclear.
Methods:
All patients from the Swedish National Patient Register with MASLD-related MALO between 2006 and 2022 were identified, and matched for age, sex and diagnosis year, with individuals having MASLD without MALO, and population controls. Hierarchical clustering using International Classification of Diseases-10 codes was employed for identifying comorbidities, with comparison between the groups. Median times of comorbidities until MALO were calculated.
Results:
996 patients with MASLD-related MALO and median age of 67 years (IQR=60-73), of which 49% men, were matched with 3921 individuals with MASLD without MALO and 9056 population controls. A median of nine comorbidity categories was observed in patients with MALO, who exhibited a cardiometabolic cluster with type 2 diabetes (49%) and hypertension (56%), which were diagnosed 6 years before MALO. Heart failure and atrial fibrillation/flutter preceded MALO in 13% and 14% and were diagnosed 4 years beforehand. Myocardial infarction occurred 6 years prior to MALO in 8%, while angina pectoris developed 8 years prior in 14% of patients. Sleep disorders were seen 8 years before MALO in 14% of patients. All identified comorbidities were present at lower rates in individuals with MASLD without MALO and population controls (p<0.001).
Conclusions:
Patients with MASLD-related MALO are frequently multimorbid. Cardiac disease and sleep disorders, with cardiometabolic risk factors, characterise individuals developing MALO. These patterns may simplify case finding and earlier interventions.
Insights
Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who develop major adverse liver outcomes (MALOs) often have preceding cardiac disease and sleep disorders. These comorbidities, including cardiometabolic risk factors, appear years before MALO.
Area of Science:
- Hepatology
- Cardiology
- Metabolic Disorders
Background:
- The comorbidities preceding major adverse liver outcomes (MALOs) in metabolic dysfunction-associated steatotic liver disease (MASLD) are not well understood.
- MASLD is a growing global health concern with significant liver-related morbidity.
Purpose of the Study:
- To identify and characterize the patterns of comorbidities that precede MALOs in patients with MASLD.
- To compare comorbidity prevalence between MASLD patients with and without MALOs, and with population controls.
Main Methods:
- Retrospective cohort study using the Swedish National Patient Register (2006-2022).
- Patients with MASLD-related MALO were matched with MASLD patients without MALO and population controls.
- Hierarchical clustering of International Classification of Diseases-10 codes identified comorbidities; median times to MALO were calculated.
Main Results:
- 996 patients with MASLD-related MALO were matched with 3921 MASLD controls and 9056 population controls.
- Patients with MALO had a median of nine comorbidity categories, notably a cardiometabolic cluster including type 2 diabetes (49%) and hypertension (56%), diagnosed ~6 years prior.
- Cardiac conditions (heart failure, atrial fibrillation/flutter, myocardial infarction, angina) and sleep disorders preceded MALO by 4-8 years in 8-14% of patients.
Conclusions:
- Patients with MASLD-related MALO are frequently multimorbid, with cardiac disease and sleep disorders being significant preceding conditions.
- The presence of cardiometabolic risk factors and specific cardiac and sleep disorders characterizes individuals at higher risk for MALO.
- These findings may aid in earlier case finding and intervention strategies for MASLD patients at risk of adverse liver outcomes.
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