Clinical Outcomes and Non-Invasive Testing in Metabolic Dysfunction-Associated Steatohepatitis With Cirrhosis: A Systematic Review.
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BACKGROUND AND AIMS: Metabolic dysfunction-associated steatohepatitis (MASH) with cirrhosis lacks definitive treatments and poses an increasing healthcare burden globally. We undertook a systematic literature review (SLR) to better understand the disease burden in cirrhosis due to MASH. METHODS: The SLR was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD4202458650). Embase, MEDLINE, and the Cochrane Library were searched for clinical trials, observational studies, and SLRs/meta-analyses published in 2014-2024 in MASH-related cirrhosis. This study focuses on clinical outcomes, including the role of non-invasive tests (NITs) for predicting these outcomes in patients with MASH-related cirrhosis. RESULTS: Following full-text review, 317 studies were considered eligible for inclusion. Studies on transplant-free survival, decompensation events, and hepatocellular carcinoma (HCC) in cirrhosis due to MASH were few and heterogeneous. In patients with MASH and compensated cirrhosis, transplant-free survival was lower in patients with type 2 diabetes (T2D) than in those without. Risks of decompensation increased with factors that included the presence of varices and T2D. Male sex, T2D, and high Child-Turcotte-Pugh score were risk factors for developing HCC. Three studies compared the performance of NITs for predicting liver-related events, including decompensation, but used varying definitions for these outcomes. CONCLUSIONS: This SLR identified data on a range of clinical outcomes in patients with MASH-related cirrhosis. However, there was limited evidence for certain outcomes including the role of prognostic prediction models for liver-related events in this patient population.