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Metabolic dysfunction-associated steatohepatitis in the real world: clinical burden, disease progression, and risk stratification with non-invasive tests

Year: 2026

Type: article

Abstract: BACKGROUND: Metabolic dysfunction-associated steatohepatitis (MASH) increases risk of liver-related outcomes, yet comorbidities and mortality patterns remain unclear. METHODS: Using Optum Market Clarity, we identified adults with MASH and assessed associations of comorbidities and noninvasive tests with liver outcomes and mortality via Fine-Gray models. RESULTS: 18,710 patients were identified (73.5% without cirrhosis, 9.0% with compensated cirrhosis (CC), 17.8% with decompensated cirrhosis, DC). The mortality rate was 0.82, 3.50, and 11.28 per 100 person-years (PY) for the non-cirrhosis, CC and DC subgroups, respectively. Among those without cirrhosis, progression to cirrhosis occurred at a rate of 5.71 per 100 PY. A FIB-4 score > 2.67 vs. ≤ 2.67 was associated with a seven-fold increase in mortality risk (adjusted hazard ratio [aHR] = 7.06; 95% confidence interval [CI] = 6.37–7.83). Elevated AST levels (> 40 U/L vs. ≤40 U/L; aHR = 1.38, 95% CI = 1.24–1.53) and living with ≥ 3 comorbidities (vs. none; HR:1.93, 95% CI 1.47–2.54) were also associated with increased mortality. CONCLUSION: Our findings highlight the impact of MASH on patients and show how accessible noninvasive tests can identify those at highest risk, empowering timely care at every stage.

Source: BMC Gastroenterology

DOI: 10.1186/s12876-026-04745-1