{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:30:29Z","timestamp":1784302229232,"version":"3.55.0"},"reference-count":46,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T00:00:00Z","timestamp":1681084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Metabolic dysfunction (MD)\u2010associated fatty liver disease has been proposed to identify individuals at risk of liver events irrespectively of the contemporary presence of other liver diseases. The aim of this study was to examine the impact of MD in patients cured of chronic hepatis C (CHC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>We analysed data from a real\u2010life cohort of 2611 Italian patients cured of CHC with direct antiviral agents and advanced liver fibrosis, without HBV\/HIV, transplantation and negative for hepatocellular carcinoma (HCC) history (age 61.4\u2009\u00b1\u200911.8\u2009years, 63.9% males, median follow\u2010up 34, 24\u201340\u2009months). Information about ultrasonographic steatosis (US) after sustained virological response was available in 1978.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MD affected 58% of patients, diagnosed due to the presence of diabetes (MD\u2010diabetes, 19%), overweight without diabetes (MD\u2010overweight, 37%) or multiple metabolic abnormalities without overweight and diabetes (MD\u2010metabolic, 2%). MD was more frequent than and not coincident with US (32% MD\u2010only, 23% MD\u2010US and 13% US\u2010only). MD was associated with higher liver stiffness (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), particularly in patients with MD\u2010diabetes and MD\u2010only subgroups, comprising older individuals with more advanced metabolic and liver disease (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). At Cox proportional hazard multivariable analysis, MD was associated with increased risk of HCC (HR 1.97, 95% CI 1.27\u20133.04; <jats:italic>p<\/jats:italic>\u2009=\u20090.0023). Further classification according to diagnostic criteria improved risk stratification (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), with the highest risk observed in patients with MD\u2010diabetes. Patients with MD\u2010only appeared at highest risk since the sustained virological response achievement (<jats:italic>p<\/jats:italic>\u2009=\u20090.008), with a later catch\u2010up of those with combined MD\u2010US, whereas US\u2010only was not associated with HCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MD is more prevalent than US in patients cured of CHC with advanced fibrosis and identifies more accurately individuals at risk of developing HCC.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15577","type":"journal-article","created":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T07:59:08Z","timestamp":1681113548000},"page":"1593-1603","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Metabolic dysfunction outperforms ultrasonographic steatosis to stratify <scp>hepatocellular carcinoma<\/scp> risk in patients with advanced hepatitis C cured with <scp>direct\u2010acting antivirals<\/scp>"],"prefix":"10.1111","volume":"43","author":[{"given":"Serena","family":"Pelusi","sequence":"first","affiliation":[{"name":"Department of Transfusion Medicine Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-6781","authenticated-orcid":false,"given":"Cristiana","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Colombo","sequence":"additional","affiliation":[{"name":"Liver Center, San Raffaele Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Cologni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Papa Giovanni Hospital  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"del Poggio","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Papa Giovanni Hospital  Zingonia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6466-1412","authenticated-orcid":false,"given":"Nicola","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Hepatology, Department of Gastroenterology IRCCS Humanitas Research Hospital  Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2281-7498","authenticated-orcid":false,"given":"Daniele","family":"Prati","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Graciella","family":"Pigozzi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Spedali Civili Hospital  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-1153","authenticated-orcid":false,"given":"Roberta","family":"D'Ambrosio","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1026-7476","authenticated-orcid":false,"given":"Pietro","family":"Lampertico","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology  Milan Italy"},{"name":"Department of Pathophysiology and Transplantation CRC \u2018A. 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