Noninvasive Hepatic Steatosis and Fibrosis Indices Differentially Predict Mortality in the Adult Korean Population.

Background & Aims: Because the association of hepatic fibrosis and steatosis non-invasive indices with mortality remain controversial, their association with all-cause, cardiovascular-, cancer-, and liver-related mortality was evaluated in the Korean population.

Methods: In this registry-based, cohort study, data were retrieved from the Korea National Health and Nutrition Examination Survey and mortality data from the Korean Cause of Death data registry; 40,491 individuals followed-up for a median of 8.6 years. Hepatic fibrosis was evaluated with alanine aminotransferase (AST)-to-platelet ratio index (APRI), body mass index-AST-to-alanine aminotransferase (ALT) ratio-diabetes mellitus (BARD), and metabolic dysfunction-associated fibrosis-5 (MAF-5) score, and steatosis was evaluated with liver fat score (LFS) and lipid accumulation product (LAP).

Results: Cox regression analysis showed that APRI (<1.0 vs ≥1.0) was independently associated with all-cause (hazard ratio [HR], 3.84; 95% confidence interval [CI], 2.30-6.43; C-index, 0.870), cancer (HR, 4.21; 95% CI, 1.88-9.45; C-index, 0.866), and liver-related (HR, 25.36; 95% CI, 11.02-58.38; C-index 0.909) mortality. MAF-5 (<1.0 vs ≥1.0) was independently associated with all-cause mortality (HR, 1.50; 95% CI, 1.10-2.03; C-index, 0.868) and liver-related mortality (HR, 8.35; 95% CI, 3.58-19.46; C-index, 0.911). LFS (<1.257 vs ≥1.257) was independently associated with all-cause (HR, 1.55; 95% CI, 1.14-2.12; C-index, 0.872) and liver-related (HR, 7.00; 95% CI, 1.63-29.96; C-index, 0.887) mortality. LAP (<38.05 vs ≥38.05) was independently associated with cardiovascular mortality (HR, 2.23; 95% CI, 1.40-3.58; C-index, 0.898). BARD was not associated with mortality.

Conclusions: APRI, MAF-5, and LFS were independently associated with all-cause mortality, LAP (cutoff, 38.05) with cardiovascular mortality, APRI with cancer mortality, and APRI, MAF-5, and LFS with liver-related mortality in the adult Korean population.