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Creatinine clearance rate predicts all-cause and cardiovascular mortality in patients with MASLD: a Shanghai cohort
Yingqi Hou1,2,3, Yanqiu Huang4, Chenghao Zhang4
1Department of Clinical Laboratory, Zhongshan Second People's Hospital, Zhongshan, China.
Insights
Higher creatinine clearance rate (CCR) is linked to reduced mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) patients. This finding suggests CCR is a valuable marker for predicting survival in individuals with MASLD.
Area of Science:
- Nephrology
- Hepatology
- Cardiology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern.
- Identifying prognostic factors for MASLD is crucial for patient management.
- Creatinine clearance rate (CCR) is an indicator of kidney function, but its role in MASLD mortality is unclear.
Purpose of the Study:
- To investigate the association between CCR and long-term mortality in MASLD patients.
- To evaluate CCR as a prognostic marker for survival in this population.
Main Methods:
- A five-year cohort study of 8,828 MASLD adults in Shanghai.
- Analysis included Kaplan-Meier survival, LASSO regression, restricted cubic splines, and Cox proportional hazards models.
- Sensitivity analyses were performed to ensure result robustness.
Main Results:
- A higher CCR was significantly associated with lower cardiovascular and all-cause mortality.
- Patients in higher CCR tertiles exhibited reduced mortality risk compared to the lowest tertile.
- Restricted cubic splines indicated a non-linear relationship between CCR and mortality.
Conclusions:
- Elevated CCR independently predicts reduced all-cause and cardiovascular mortality in MASLD patients.
- CCR can serve as a valuable renal function-related prognostic marker for risk stratification.
- These findings highlight the importance of renal function assessment in MASLD management.
Background:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition globally, driving the need to identify prognostic risk factors. The creatinine clearance rate (CCR) serves as a sensitive early marker of glomerular filtration rate. Yet evidence regarding its specific association with mortality in MASLD patients remains limited.
Method:
The predictive value of the CCR for long-term survival was evaluated in a five-year cohort of adults with MASLD from Pudong District, Shanghai. Baseline characteristics were analyzed, and Kaplan-Meier survival analysis, LASSO regression, restricted cubic splines (RCS), and Cox proportional hazards models were employed to assess the relationship between the CCR and mortality risk, with sensitivity analyses conducted to test robustness.
Results:
Among 8,828 MASLD patients, a higher CCR was inversely associated with cardiovascular mortality (HR = 0.95; 95% CI: 0.95-0.96) and all-cause mortality (HR = 0.97; 95% CI: 0.96-0.97) (both P < 0.001). Compared to the lowest tertile (T1), the middle (T2) and highest (T3) tertiles showed lower risks (P for trend < 0.05). RCS analysis revealed a non-linear correlation for both outcomes (P for non-linearity < 0.05). Kaplan-Meier curves confirmed higher survival probabilities in the highest CCR tertile (log-rank P < 0.001). LASSO regression was used for variable selection and CCR was included in the multivariate prognostic model, suggesting that this index is valuable for model fitting and can serve as an auxiliary indicator for predicting mortality risk in patients with MASLD, which was supported by ROC analysis. Sensitivity analyses confirmed the stability of these findings.
Conclusion:
In this cohort of Shanghai adults with MASLD, a higher estimated creatinine clearance rate was independently associated with a significantly reduced risk of all-cause and cardiovascular mortality. CCR may serve as a valuable renal function-related prognostic marker for risk stratification in the MASLD population.
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