Long-term outcomes of Metabolic dysfunction associated steatotic liver disease (MASLD) patients in a prospective, German real-world cohort

Background: MASLD is the most frequent liver disease but longitudinal data of clinical outcomes in Germany are lacking. Aim of this study is to analyse long-term outcomes in a prospective, German real-world cohort.

Methods: 310 MASLD patients diagnosed by histology or liver stiffness/CAP were prospectively followed (2012–2023). Statistical analyses of liver-related outcomes and mortality were conducted using SPSS.

Results: 310 MASLD patients were followed for a median of 36±16 months (56.8% male, mean age 52.3 years, mean BMI 32.5±6.4kg/m²), 40% had T2DM, 58% arterial hypertension and 36% hypercholesterinemia. 36% were diagnosed histologically (of those 36.9% F2-F4) and 59% staged by elastography (12% LS 8-12kPa, 21%>12kPa). Longterm-FU showed that patients with cirrhosis had significantly more liver-related outcomes compared to those without (HR 3.501 (95%-CI 1.835-6.682)) and a higher mortality (HR 11.572 (95%-CI 3.030-44.194)). Patients with F2-F3 in histology had a higher rate of liver-related outcomes compared to F0-F1 (HR 3.638 (95%-CI 1.345-9.840)). Stratified by LS, the highest rate of liver-related outcomes was detected for>12kPa (HR 11.738 (95%-CI 4.421-31.167)) followed by 8-12kPa (HR 4.630 (95%-CI 1.514-14.160)), both compared to<8kPa. Mortality was similarly increased for>12kPa (HR 13.489 (95%-CI 1.622-112.152)) and 8-12kPa (HR 6.044 (95%-CI 0.546-66.876)). In the longitudinal study 3.5% (n=11) of patients died, 3 due to liver-related complications.

Conclusion: In this first German longitudinal MASLD cohort, patients with significant fibrosis or cirrhosis have the highest risk for liver-related outcomes and overall mortality. This underscores the need for regular monitoring of at-risk-patients.

Publication History

Article published online:
20 January 2025