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Meta-Analysis
. 2025 Sep;138(9):1238-1247.e4.
doi: 10.1016/j.amjmed.2025.04.027. Epub 2025 Apr 30.

Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis

Do Han Kim  1 , Donghyun Ko  2 , Pojsakorn Danpanichkul  3 , Glenn Jun Kit Ho  4 , Faith Xin Ning Tan  4 , N Apoorva Sasikumar  4 , Ethan Kai Jun Tham  4 , Daniel Q Huang  5 , Nicholas Syn  4 , Ming-Hua Zheng  6 , Takumi Kawaguchi  7 , Yoshio Sumida  8 , Atsushi Nakajima  9 , Hirokazu Takahashi  10 , Mazen Noureddin  11 , Cheng Han Ng  12 , Mark D Muthiah  13 , Karn Wijarnpreecha  14
Affiliations
Meta-Analysis

Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis

Do Han Kim et al. Am J Med. 2025 Sep.

Abstract

Introduction: The updated consensus introduces "steatotic liver disease" as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential.

Methods: A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes.

Results: A total of 13 studies, involving 17.6 million patients were included. Of these, 6.8 million individuals were diagnosed with steatotic liver disease. Subtype analysis revealed a significant increase in liver-related events and composite cardiovascular outcomes across all steatotic liver disease subtypes compared to non-steatotic liver disease. Patients with MetALD and alcohol-associated liver disease were associated with a higher risk of all-cause mortality when compared to non-steatotic liver disease. Compared to MASLD, patients with MetALD and alcohol-associated liver disease significantly elevated the risk of liver-related events and individuals with alcohol-associated liver disease were associated with increased risk of all-cause mortality. Sensitivity analysis demonstrated that certain mortality outcomes were no longer significant.

Conclusion: Individuals across steatotic liver disease face an elevated risk of liver-related events, liver cancer, and cardiovascular outcomes. For liver-related events, the risk is progressively higher across MASLD, MetALD, and alcohol-associated liver disease, respectively. Misclassification may be introduced when using different diagnostic methods, leading to changes in outcomes. These findings validate the impact of the new classification in predicting outcomes.

Keywords: Alcohol-related liver disease; Chronic liver disease; Metabolic dysfunction-associated steatotic liver disease.

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