METHODS: We investigated a nationwide population-based cohort and identified 633 279 patients with MASLD, with a mean follow-up of 4.2 years. Hemoglobin A1c levels were measured annually. The primary endpoint was the risk of liver-related events and MACE and to determine the optimal HbA1c level associated with the risk of complications.
RESULTS: Mean HbA1c (per 1%) was associated with liver-related events (subdistribution hazard ratio [sHR] 1.26; 95% confidence interval [CI], 1.12-1.42) as well as MACE (sHR 1.36; 95% CI, 1.32-1.41) after adjustment for confounders. Multivariable sHR (95% CI) for HbA1c of <5.0%, 6.0%-6.9%, 7.0%-7.9%, 8.0%-8.9%, and ≥9.0% (reference, 5.0%-5.9%) were 14 (9.1-22), 1.70 (1.2-2.3), 3.32 (2.3-4.8), 3.81 (2.1-6.8), and 4.83 (2.4-9.6) for liver-related events, and 1.24 (0.8-1.8), 1.27 (1.2-1.4), 1.70 (1.5-2.0), 2.36 (1.9-2.9), and 4.17 (3.5-5.0) for MACE. An HbA1c level of 7% was selected as the optimal threshold for predicting complications (sHR 2.40 [1.8-3.2] for liver-related events and 1.98 [1.8-2.2] for MACE).
CONCLUSIONS: The risk of liver-related events as well as MACE increased in a dose-dependent fashion with an increase in HbA1c levels, except for patients with HbA1c <5.0% for liver-related events. An HbA1c level of 7% was the optimal threshold associated with a lower risk of complications and may be utilized as a target for glycemic control in patients with MASLD.
方法:我们调查了一个全国人群队列,确定了633.279名MASLD患者,平均随访4.2年。每年测量血红蛋白A1c水平。主要终点是肝脏相关事件和MACE的风险,并确定与并发症风险相关的最佳HbA1c水平。
结果:平均HbA1c(每1%)与肝脏相关事件相关(亚分布风险比[sHR]1.26;95%置信区间[CI],1.12-1.42)以及校正混杂因素后的MACE(sHR1.36;95%CI,1.32-1.41)。HbA1c的多变量sHR(95%CI)<5.0%,6.0%-6.9%,7.0%-7.9%,8.0%-8.9%,且≥9.0%(参考,5.0%-5.9%)为14(9.1-22),1.70(1.2-2.3),3.32(2.3-4.8),3.81(2.1-6.8),和4.83(2.4-9.6)肝脏相关事件,和1.24(0.8-1.8),1.27(1.2-1.4),1.70(1.5-2.0),2.36(1.9-2.9),和4.17(3.5-5.0)的MACE。选择7%的HbA1c水平作为预测并发症的最佳阈值(肝脏相关事件的sHR为2.40[1.8-3.2],MACE的sHR为1.98[1.8-2.2])。
结论:随着HbA1c水平的升高,肝脏相关事件和MACE的风险呈剂量依赖性增加,除了HbA1c<5.0%的患者与肝脏相关的事件。7%的HbA1c水平是与并发症风险较低相关的最佳阈值,并且可以用作MASLD患者的血糖控制的目标。