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 μg/L (median HR=1.71 and C-index=0.71) and the risk of overall mortality from threshold 272 μg/L (median HR=1.49 and C-index=0.70). The inclusion of serum ferritin thresholds (215.5 μg/L and 272 μg/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.

Serum ferritin levels can predict long-term outcomes in patients with metabolic dysfunction-associated steatotic liver disease / A. Armandi, T. Sanavia, R. Younes, G. Paolo Caviglia, C. Rosso, O. Govaere, A. Liguori, P. Francione, R. Gallego-Duràn, J. Ampuero, G. Pennisi, R. Aller, D. Tiniakos, A. Burt, E. David, F. Vecchio, M. Maggioni, D. Cabibi, D. Mcleod, M. Jesus Pareja, M.Y. W Zaki, A. Grieco, P. Stål, S. Kechagias, A.L. Fracanzani, L. Valenti, L. Miele, P. Fariselli, M. Eslam, S. Petta, H. Hagström, J. George, J. M Schattenberg, M. Romero-Gómez, Q. Mark Anstee, E. Bugianesi. - In: GUT. - ISSN 0710-5843. - 73:5(2024 Apr 05), pp. 825-834. [10.1136/gutjnl-2023-330815]

Serum ferritin levels can predict long-term outcomes in patients with metabolic dysfunction-associated steatotic liver disease

A.L. Fracanzani;L. Valenti;
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 μg/L (median HR=1.71 and C-index=0.71) and the risk of overall mortality from threshold 272 μg/L (median HR=1.49 and C-index=0.70). The inclusion of serum ferritin thresholds (215.5 μg/L and 272 μg/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.
FIBROSIS; NONALCOHOLIC STEATOHEPATITIS;
Settore MED/09 - Medicina Interna
5-apr-2024
10-gen-2024
GUT
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1050100
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