Clinical Outcomes and Non-Invasive Testing in Metabolic Dysfunction-Associated Steatohepatitis With Cirrhosis: A Systematic Review

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.