ArticleThe Kaohsiung journal of medical sciences2026
Stage-Dependent Prognostic Value of the Joint MASLD-NAFLD Fibrosis Score Phenotype Across the Cardiovascular-Kidney-Metabolic Syndrome Continuum: A Retrospective NHANES Cohort Analysis, 1999-2018.
Article in The Kaohsiung journal of medical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The cardiovascular-kidney-metabolic (CKM) framework and metabolic dysfunction-associated steatotic liver disease (MASLD) describe a shared clinical continuum, but the prognostic value of joint fatty liver index (FLI)-NAFLD fibrosis score (NFS) phenotypes across CKM stages is uncertain. We analyzed 10 National Health and Nutrition Examination Survey cycles (1999-2018) linked to mortality through 2019. Among 31,317 adults, participants were classified as A (no MASLD/NFS-low), B (MASLD/NFS-low), C (no MASLD/NFS-high), or D (MASLD/NFS-high) and stratified by operational CKM Stages 0-4. Survey-weighted survival analyses and Cox models incorporated 20-imputation covariate analysis; exposure, outcome, follow-up, and survey-design fields were not imputed. During 291,392.5 person-years, 4284 all-cause and 1417 cardiovascular deaths occurred. All-cause survival differed across phenotypes in Stages 2-4 (p < 0.001 for each), but not between A and B in Stage 1 (p = 0.695). At Stage 2, adjusted D-versus-A hazard ratios were 1.57 (95% CI 1.30-1.91) for all-cause mortality and 2.09 (1.57-2.79) for cardiovascular mortality; corresponding Stage 4 estimates were 1.44 (1.21-1.70) and 1.25 (0.96-1.64). The full stage interaction was non-estimable, and supported-stage interaction p values were 0.113 and 0.122. Joint-phenotype associations varied across supported CKM stages, but sparse early-stage phenotypes, a small apparent discrimination gain, and nominal subgroup findings support external validation rather than immediate clinical deployment.
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