Serum ferritin values may improve risk stratification of MASLD patients

Baseline hyperferritinemia occurred in almost one-third of study patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and was associated with higher stages of fibrosis.

Use of serum ferritin levels improved the performance of the Fibrosis-4 Score (FIB-4) and Non-Alcoholic Fatty Liver Disease Fibrosis (NFS) Score for predicting liver-related events and all-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), a study found.

To assess the role of serum ferritin in predicting long-term outcomes or death in MASLD (formerly called nonalcoholic fatty liver disease [NAFLD]), researchers enrolled 1,342 patients in Italy, the United Kingdom, Spain, Germany, Sweden, and Australia in a multicenter cohort. Four survival models considering ferritin with confounders or noninvasive scoring systems were applied. Outcomes included liver-related outcomes (ascites, hepatic encephalopathy, esophageal varices bleeding), hepatocellular carcinoma, cardiovascular events (including acute coronary syndrome, peripheral arterial ischemia, acute cerebrovascular events), extrahepatic cancer, and all-cause mortality. Results were published Jan. 10 by Gut.

Over a median follow-up of 96 months, liver-related events occurred in 7.7% of patients, hepatocellular carcinoma occurred in 1.9%, cardiovascular events occurred in 10.9%, extrahepatic cancer occurred in 8.3%, and all-cause mortality occurred in 5.8%. Hyperferritinemia was associated with a 50% increased risk of liver-related events and a 27% increased risk of all-cause mortality. The risk for liver-related events and overall mortality mainly increased from threshold serum ferritin levels of 215.5 μg/L (median hazard ratio [HR],1.71) and 272 μg/L (median HR, 1.49), respectively. Inclusion of these serum ferritin thresholds improved the performance of the FIB-4 and NFS scores in assessing liver-related events and overall mortality.

The authors noted that data on cause of death were missing and that the results may not apply to patients in the general population, among other limitations. “In conclusion, this longitudinal study strongly suggests that ferritin levels should be considered as an additional tool in the risk stratification of patients with MASLD, particularly in terms of liver-related events and overall mortality, and this finding deserves to be validated in prospective cohort studies,” they wrote.