Differences in the incidence of cirrhosis-associated complications between MASLD, MetALD and ALD among patients with decompensated liver cirrhosis.

Abstract

BackgroundRecently, the new definition of steatotic liver disease (SLD) has been introduced, which not only differentiates MASLD (Metabolic Dysfunction-Associated steatotic liver disease) from alcohol-related steatotic liver disease (ALD), but also introduces the concept of metabolic and alcohol-related SLD (MetALD). However, potential differences of the new etiologies regarding the clinical phenotype of patients with advanced liver cirrhosis still remain undetermined. Therefore, we analyzed survival and the incidence of cirrhosis-related complications in SLD-patients with advanced liver cirrhosis.MethodsA number of 416 consecutive patients with MASLD, MetALD- and ALD-associated decompensated liver cirrhosis were investigated. Overall survival, infections, hepatic encephalopathy, portal-hypertensive bleeding, rehospitalization and development of hepatocellular carcinoma were retrospectively analyzed within one year of follow-up. Cox regression analyses were performed for survival, competing risk analyses for the cirrhosis-specific complications. MASLD was used as reference group.ResultsALD was associated with a lower risk of infections (HR = 0.55; p ConclusionThe risk of infections is increased in MASLD-associated cirrhosis compared to other SLD-phenotypes. Thus, the role of a metabolic risk profile should not be neglected even in patients with decompensated liver cirrhosis.