LONGITUDINAL CHANGES IN STEATOTIC LIVER DISEASE SUBTYPE CLASSIFICATION AND SUBSEQUENT RISK OF MAJOR ADVERSE LIVER OUTCOMES

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Steatotic liver disease (SLD) includes metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and their intersection (MetALD). SLD subtype classification may change over time; however, the impact of these transitions on major adverse liver outcomes (MALO) is unknown. We conducted a retrospective study of adults with imaging-confirmed steatosis (n=270,302) in the Veterans Health Administration (2010-2021). The primary exposure was change in SLD subtype classification between cohort entry (steatosis on imaging) and a 2-year landmark. The primary outcome was incident MALO (cirrhosis, decompensation, HCC, transplant, liver-related death). We calculated incidence rates per 100 person-years and multivariable cause-specific Cox regression models to examine the magnitud of the association between changes in SLD subtype and subsequent MALO. At the 2-year landmark, 8.2% of those with baseline MASLD were reclassified to MetALD or ALD, 34.2% of those with baseline MetALD were reclassified to MASLD or ALD, and 64.0% of those with baseline ALD were reclassified to MASLD or MetALD. Among baseline MASLD, the risk of MALO was higher for those reclassified to MetALD (HR 1.55;95% CI 1.40-1.71) or ALD (HR 2.13;95% CI 1.66-2.74) compared with those who remained MASLD. Among baseline MetALD, the risk of MALO was lower for those reclassified to MASLD (HR 0.55;95% CI 0.48-0.64) and higher for those reclassified to ALD (HR 1.80;95% CI 1.58-2.06) compared with those who remained MetALD. Among baseline ALD, the risk of MALO was lower for those reclassified to MASLD (HR 0.31;95% CI 0.21-0.46) or MetALD (HR 0.82;95% CI 0.70-0.96) compared with those who remained ALD. Changes in SLD subtype classification are associated with distinct MALO risks.

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