Syed Muhammad Hassan Bukhari, MBBS, of Darlington Memorial Hospital NHS England, and colleagues conducted the study and presented their findings at the British Association for the Study of the Liver (BASL) Annual Meeting 2026. The abstract was published in Gut.
The investigators sought to analyze predictors of MASLD mortality and unfavorable outcomes, with a specific focus on high-risk phenotypes, cardiometabolic burden, fibrosis stage, and noninvasive markers. The investigators also evaluated predictors of mortality driven by hepatic and extrahepatic complications.
Data from PubMed and PubMed Central, published between 2010 and 2026, informed the systematic review, which was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were those that included reports of mortality outcomes for patients with MASLD, as well as nonalcoholic fatty liver disease (NAFLD), the previous name for MASLD.
The investigators explained that all studies were screened for “predefined inclusion criteria,” with information on fibrosis stage, liver stiffness, lean phenotype, cardiometabolic risk, type 2 diabetes (T2D), chronic kidney disease (CKD), and Fibrosis-4 (FIB-4) score extracted for further qualitative analysis and pooled estimates.
Among the 131 studies that were included in the systematic review and meta-analysis, fibrosis stage emerged as the “strongest predictor of mortality.” Advanced fibrosis stage correlated with a significant increase in “all-cause and liver-related mortality.”
The findings also revealed that FIB-4 scores and noninvasive biomarkers were predictive of unfavorable outcomes for patients with MASLD. Cardiovascular mortality was shown to be more prominent than liver-related mortality across the selected study populations.
The investigators reported various significant risk amplifiers identified through their analysis, which included cardiometabolic burden, CKD, and T2D. Additional notable findings highlighted that “lean MASLD was associated with increased mortality despite lower BMI.”
Overall, the investigators underscored that the primary drivers of MASLD mortality were identified as progression of fibrosis and systemic metabolic dysfunction. They suggested that future risk stratification for mortality in MASLD care should include assessments of fibrosis and cardiometabolic burden.
In reflecting on the impact of their research findings for patients, investigators concluded, “Early identification of high-risk patients is essential to reduce future disease burden.”
