Association between systemic inflammation markers and cardiovascular mortality in adults with metabolic dysfunction-associated steatotic liver disease

Background and aim Identifying metabolic dysfunction-associated steatotic liver disease (MASLD) patients at increased risk of cardiovascular mortality remains an unmet clinical need. We investigated the ability of four systemic inflammation markers to identify cardiovascular mortality risk in MASLD patients. Methods and results This cohort study included 4787 MASLD patients from the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2018. The weighted Cox proportional hazards model was used to assess the relationship between four systemic indicators of inflammation and cardiovascular mortality. During a median (IQR) follow-up of 7.0 (3.8-10.3) years, 567 all-cause mortality and 174 cardiovascular mortality were recorded. Compared to the first quartile of systemic inflammation levels, the HRs of cardiovascular mortality in the fourth quartile were 3.22 (95 % CI 1.83-5.66) for SII, 2.74 (95 % CI 1.32-5.69) for SIRI, 3.69 (95 % CI 1.87-7.28) for NLR, and 1.83 (95 % CI 1.05-3.20) for PLR. For predicting 10-year cardiovascular mortality, SIRI (AUC = 0.70) and NLR (AUC = 0.69) were superior to SII (AUC = 0.60) and PLR (AUC = 0.52). Stratification of MASLD patients based on the optimal cutoff values revealed an HR of 2.67 (95 % CI 1.65-4.32) for cardiovascular mortality with SIRI > 1.23, and an HR of 2.39 (95 % CI 1.51-3.79) with NLR > 2.18. Combining systemic inflammation markers with the Fibrosis-4 Score can provide more accurate prognostic information for MASLD patients. Conclusions SIRI and NLR outperformed SII and PLR in predicting the risk of cardiovascular mortality, proving to be useful tools for risk stratification in MASLD patients.