The Metabolic Vulnerability Index predicts risk of mortality and liver outcomes in patients with nonalcoholic fatty liver disease, according to a study presented at the 2021 American Association for the Study of Liver Diseases meeting.

This study was presented by Arun J. Sanyal, MD, Virginia Commonwealth University, Richmond.

“The Metabolic Vulnerability Index… is a novel combination of Nuclear Magnetic Resonance (NMR) parameters reflecting core elements of “metabolic vulnerability” arising from inflammation and amino acid dysmetabolism developed by Labcorp to predict mortality risk in the general population,” explained Dr Sanyal and colleagues.

“It is composed of the inflammation marker GlycA and small HDL particles along with markers of metabolic inflexibility leucine, valine, isoleucine and citrate,” they wrote.

This study aimed to examine the ability of the Metabolic Vulnerability Index to predict mortality in nonalcoholic fatty liver disease.

Serum samples collected within 6 months of a liver biopsy demonstrating nonalcoholic fatty liver disease were analyzed. The Nonalcoholic Steatohepatitis (NASH) Clinical Research Network system scored histology. The Metabolic Vulnerability Index was scored from 0 to 100 with higher values indicating higher risk for mortality.

Cox regression was used to assess the Metabolic Vulnerability Index as a predictor of all-cause mortality, hepatic decompensation, Type 2 diabetes mellitus (T2DM), coronary artery disease, 40% decline in estimated glomerular filtration rate, and extra-hepatic cancer (adjusting for age, race, sex, T2DM, nonalcoholic activity score, NASH status, and fibrosis stage).

A total of 1613 patients with a mean follow-up of 4.8 person-years were included in the study. At baseline, the mean age was 52 years, 85% of patients were Caucasian, 42% had T2DM, 55% had definite steatohepatitis, and 20% had borderline steatohepatitis. The mean nonalcoholic activity score was 4.2 and mean fibrosis stage was 1.6.

During follow-up, event rates for all-cause mortality, liver decompensation, and >40% estimated glomerular filtration rate decline were higher with increasing levels of Metabolic Vulnerability Index. The hazard ratios per 10-point increase in Metabolic Vulnerability Index were 2.59 for all-cause mortality (P <.0001), 1.64 for liver decompensation (P = .003), 1.04 for T2DM (P = .58), 1.04 for coronary artery disease (P = .78), 1.4 for >40% estimated glomerular filtration rate decline (P = .002), and 1 for extrahepatic cancer (P = .99).

“The MVX [Metabolic Vulnerability Index] significantly predicts the risk of death, hepatic decompensation and decline in eGFR [estimated glomerular filtration rate] in a mixed general population with NAFLD [nonalcoholic fatty liver disease],” concluded Dr Sanyal and colleagues.

—Janelle Bradley

Reference

Sanyal AJ, et al. The Metabolic Vulnerability Index Predicts the Risk of Mortality and Liver Outcomes in Nonalcoholic Fatty Liver Disease. Presented at: The American Association for the Study of Liver Diseases meeting, November 12-15, 2021; virtual.