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High burden of potentially undiagnosed MASH in a general population in Sweden
Emilie Toresson Grip1, Ron Basuroy2, Pierre Johansen2
1Quantify Research AB, Hantverkargatan 8, 11221 Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Background And Aims:
Few studies have explored the prevalence and outcomes of fibrotic metabolic dysfunction-associated steatohepatitis (MASH) in the general population. We aimed to characterize patients at risk of MASH using the validated Fibrotic NASH Index (FNI) and to compare the incidence of major adverse liver outcomes (MALO), major adverse cardiovascular events (MACE) and mortality between FNI risk groups and patients with established MASH.
Methods:
Patients were classified as high risk (FNI≥0.33 and ≥ 1 cardiometabolic risk factor), or low-risk (FNI<0.1 +/- cardiometabolic risk factors) using laboratory data from routine clinical care in Stockholm, Sweden in 2010-2020. Patients with established MASH had a recorded ICD-10 code (K75.8) in Swedish specialist care (1998-2022). Data were analysed using Cox regression models and MALO, MACE and mortality were measured in number of events, cumulative incidence, and incidence rates.
Results:
FNI was available in 162,456 patients, of which 23% were considered at high risk of MASH, and 39% considered low-risk. Among patients with established MASH (n=615), MALO's were more common than in high-risk FNI patients (45% vs 0.6%) at baseline. The rate of incident MALO was higher in diagnosed MASH patients vs the high-risk FNI group (adjusted HR [aHR]=6.73, 95%CI=4.03-11.23) and higher in high vs low-risk FNI group (aHR=4.6, 95%CI=3.9-5.4). The rate of MACE was also higher in high- vs low-risk (aHR=1.8, 95%CI=1.7-1.8) but not significantly different in high-risk vs diagnosed patients (aHR=0.6, 95%CI=0.3-1.2).
Conclusion:
There is a large burden of potentially undiagnosed at-risk MASH in patients from a general population with risk factors for MASH. Almost half of patients with established MASH already have MALO at baseline, reinforcing the need for earlier diagnosis.
