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Association between the aMAP risk score and mortality in the MASLD/MetALD/ALD patient population: a cohort study
Peng-Yang Li1, Yuan-Xin Mo2, Rui-Biao Fu1
1Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region (Guangxi Academy of Medical Sciences), Nanning, China.
Background:
The age-male-ALBI-platelets (aMAP) risk score, an emerging non-invasive marker for liver fibrosis and hepatocellular carcinoma, has shown potential in risk stratification. However, its association with mortality in the broader population of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), MetALD, and Alcohol-related Liver Disease (ALD) remains unclear. Elucidating this relationship is crucial for healthcare and public health.
Methods:
We performed a cohort study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. We used multivariable Cox proportional hazards models, Restricted cubic spline (RCS) analysis and Kaplan-Meier curves to assess the association between the aMAP score and all-cause, cardiovascular, and cancer mortality risks. The Fine-Grey competing risk analyses were used as a supplement. Mortality data were ascertained via the National Death Index through December 31, 2019. An independent hospital-based Southern Chinese cohort (n = 642) was additionally included for external validation of the association between aMAP score and MASLD.
Results:
A total of 32,654 participants were included. The prevalence of MASLD, MetALD, and ALD was 41.14, 2.22, and 0.79%, respectively. RCS analysis revealed a non-linear relationship between aMAP and all-cause mortality in all SLD subclassifications. Kaplan-Meier curves confirmed significantly lower survival rates in participants with higher aMAP scores. After multivariable adjustment, the high aMAP risk group (>60) had a significantly higher risk of all-cause, cardiovascular, and cancer mortality in most SLD classifications. This association remained robust in subgroup analyses for MASLD (HR: 1.11), MetALD (HR: 1.39), and ALD (HR: 1.87) on all-cause mortality. In the external validation cohort, elevated aMAP scores were also associated with higher odds of MASLD, showing an overall positive and approximately linear relationship. External validation demonstrated the linear association between aMAP and MASLD.
Conclusion:
The aMAP score is independently associated with long-term mortality risk across the whole subgroup of steatotic liver disease. As a readily available and effective risk-stratification tool, the aMAP stratification can help identify high-risk individuals within all SLD subclassifications and support clinical application and resource allocation. The association of aMAP with prevalence of MASLD was further supported by findings from an independent hospital-based validation cohort.
Insights
The age-male-ALBI-platelets (aMAP) score predicts mortality in steatotic liver disease (SLD). Higher aMAP scores correlate with increased risks of death from all causes, cardiovascular issues, and cancer across MASLD, MetALD, and ALD.
Area of Science:
- Hepatology
- Non-invasive biomarkers
- Public health
Background:
- The age-male-ALBI-platelets (aMAP) score is an emerging non-invasive marker for liver fibrosis and hepatocellular carcinoma.
- Its association with mortality in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), MetALD, and Alcohol-related Liver Disease (ALD) is not well-established.
- Understanding this link is vital for public health and clinical decision-making.
Purpose of the Study:
- To investigate the association between the aMAP score and mortality risks (all-cause, cardiovascular, cancer) in individuals with steatotic liver disease (SLD).
- To validate the association of the aMAP score with MASLD prevalence in an independent cohort.
Main Methods:
- A large cohort study using NHANES data (1999-2018) with mortality follow-up through 2019.
- Multivariable Cox proportional hazards models, Restricted Cubic Spline (RCS) analysis, and Kaplan-Meier curves were employed.
- Fine-Grey competing risk analyses and an independent Southern Chinese cohort for external validation were utilized.
Main Results:
- A total of 32,654 participants were analyzed, with MASLD, MetALD, and ALD prevalence at 41.14%, 2.22%, and 0.79%.
- RCS analysis showed a non-linear relationship between aMAP score and all-cause mortality across SLD subtypes.
- Higher aMAP scores were significantly associated with increased risks of all-cause, cardiovascular, and cancer mortality, with robust findings in subgroup analyses for MASLD, MetALD, and ALD.
Conclusions:
- The aMAP score is an independent predictor of long-term mortality across all steatotic liver disease subtypes.
- The aMAP score serves as an effective tool for risk stratification, identifying high-risk individuals within SLD classifications.
- External validation confirmed the association between elevated aMAP scores and higher odds of MASLD prevalence.
