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Title: | Serum ferritin levels can predict long-term outcomes in patients with metabolic dysfunction-associated steatotic liver disease |
Authors: | Armandi, A.;Sanavia, T.;Younes, R.;Caviglia, G. P.;Rosso, C.;Govaere, O.;Liguori, A.;Francione, P.;Gallego-Duran, R.;Ampuero, J.;Pennisi, G.;Aller, R.;Tiniakos, D.;Burt, A.;David, E.;Vecchio, F.;Maggioni, M.;Cabibi, D.;McLeod, Duncan;Pareja, M. J.;Zaki, M. Y. W.;Grieco, A.;Stal, P.;Kechagias, S.;Fracanzani, A. L.;Valenti, L.;Miele, L.;Fariselli, P.;Eslam, Mohammed;Petta, S.;Hagstrom, H.;George, Jacob;Schattenberg, J. M.;Romero-Gomez, M.;Anstee, Q. M.;Bugianesi, E. |
WSLHD Author: | McLeod, Duncan;Eslam, Mohammed;George, Jacob |
Subjects: | Non-alcoholic Fatty Liver Disease;Liver Cirrhosis;Fibrosis;Liver Neoplasms;Ferritins |
Issue Date: | 2024 |
Citation: | Gut 73(5):825-834, 2024 |
Abstract: | OBJECTIVE: Hyperferritinaemia is associated with liver fibrosis severity in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), but the longitudinal implications have not been thoroughly investigated. We assessed the role of serum ferritin in predicting long-term outcomes or death. DESIGN: We evaluated the relationship between baseline serum ferritin and longitudinal events in a multicentre cohort of 1342 patients. Four survival models considering ferritin with confounders or non-invasive scoring systems were applied with repeated five-fold cross-validation schema. Prediction performance was evaluated in terms of Harrell's C-index and its improvement by including ferritin as a covariate. RESULTS: Median follow-up time was 96 months. Liver-related events occurred in 7.7%, hepatocellular carcinoma in 1.9%, cardiovascular events in 10.9%, extrahepatic cancers in 8.3% and all-cause mortality in 5.8%. Hyperferritinaemia was associated with a 50% increased risk of liver-related events and 27% of all-cause mortality. A stepwise increase in baseline ferritin thresholds was associated with a statistical increase in C-index, ranging between 0.02 (lasso-penalised Cox regression) and 0.03 (ridge-penalised Cox regression); the risk of developing liver-related events mainly increased from threshold 215.5 microg/L (median HR=1.71 and C-index=0.71) and the risk of overall mortality from threshold 272 microg/L (median HR=1.49 and C-index=0.70). The inclusion of serum ferritin thresholds (215.5 microg/L and 272 microg/L) in predictive models increased the performance of Fibrosis-4 and Non-Alcoholic Fatty Liver Disease Fibrosis Score in the longitudinal risk assessment of liver-related events (C-indices>0.71) and overall mortality (C-indices>0.65). CONCLUSIONS: This study supports the potential use of serum ferritin values for predicting the long-term prognosis of patients with MASLD. Copyright Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/9555 |
DOI: | https://dx.doi.org/10.1136/gutjnl-2023-330815 |
Journal: | Gut |
Type: | Journal Article |
Department: | Storr Liver Centre |
Facility: | Westmead |
Keywords: | Gastroenterology and Hepatology |
Appears in Collections: | Westmead Hospital 2019 - 2024 |
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