MBS associated with significant reductions in the rates of adverse hepatic and extrahepatic outcomes in patients with steatotic liver disease

In patients with steatotic liver disease (SLD), metabolic bariatric surgery (MBS) is associated with significant reductions in the rates of adverse hepatic and extrahepatic outcomes and all-cause mortality after four years of follow-up, according to researchers from University of Liverpool, Liverpool, UK.

(Credit: Andrewmeyerson)

For their retrospective cohort study, the investigators identified a total of 15,262 patients with SLD and a history of MBS between 2004 and 2019 (MBS cohort) and 540,031 patients with a diagnosis of SLD occurring in the same time window and without a history of MBS (no-MBS cohort). After propensity score matching (PSM), the cohorts included 14,970 patients each.

The mean age after PSM in MBS cohort was 46.7 (±12.2) and 47.4 years (±13.9) in no-MBS cohort. 74.3% and 75.7% of all subjects were female in the MBS and no-MBS cohorts respectively. The mean follow-up was 4.1 years in both cohorts.

The hazard ratio of major adverse liver outcomes (MALO) in the primary analysis was 0.84, favouring those in the MBS cohort. The reduced hazard ratio of MALO in the MBS cohort was confirmed in subgroup analyses according to the type of surgery (SG: 0.67 (0.53–0.83); RYGB: 0.74 (0.59–0.93)), presence of metabolic risk factors (T2D: 0.75 (0.64–0.89), BMI ≥50 kg/m2: 0.69 (0.50–0.96)) and in female patients (0.85 (0.74–0.98)). In male patients and those without additional metabolic risk factors, the hazard ratio did not reach statistical significance (Males: 0.79 (0.61–1.02), no-T2D: 1.01; BMI < 50 kg/m2: 0.89 (0.77–1.02).

There was a reduction in hazard ratio of major adverse cardiovascular outcomes and all its individual components (acute myocardial infarction (MI), stroke and heart failure) in the secondary analysis and all subgroup analyses except the hazard ratio of acute MI in non-diabetic patients, which did not reach statistical significance.

The hazard ratio of major adverse kidney events was 0.54 and the reduced HR was noted in all subgroup analyses. Reduced hazard ratio of end-stage renal failure and progression to dialysis was significant in all subgroups except the non-diabetic patients. Reduced hazard ratio of chronic kidney disease 5 was significant in males, patients with a history of SG and BMI ≥50 kg/m2.

The hazard ratio of obesity-related cancers was 0.58 and similarly to previous composite outcomes, the reduced hazard ratio was confirmed in all subgroup analyses. Across the whole cohort, significant benefit from MBS was noted for cancers of colon and rectum, breast, uterus, kidney and multiple myeloma. In addition, female patients had reduced HR of ovarian and pancreatic cancers.

The hazard ratio of all-cause mortality was 0.49. The reduced HR of ACM was confirmed in all subgroup analyses. The overall risk of any complication within 30 days of MBS was 1.5%. Individual risks of leak or superficial wound infection were both 0.1%, risks of venous thromboembolism or bleeding were 0.5% and 30-day mortality was 0.2%.

“We demonstrate an association of MBS with a significant reduction in the rate of major adverse hepatic and extrahepatic clinical outcomes and lower ACM in a large cohort of patients with SLD, with benefits confirmed in individuals with significant metabolic risk factors (T2D and BMI ≥50 kg/m2) and those with a history of either SG or RYGB,” the researchers concluded. “A diagnosis of SLD should be considered a significant clinical criterion to prompt referrals of patients living with obesity to bariatric surgical centres.”

The findings were reported in the paper, ‘Metabolic bariatric surgery is associated with reduced adverse hepatic and extrahepatic outcomes, and lower all-cause mortality, in patients with steatotic liver disease’, published in Diabetes, Obesity and Metabolism. To access this paper, please click here