High aMAP Risk Scores Associated With Increased Mortality in Metabolic and Alcohol-Related Liver Disease

BackgroundThe age–male–ALBI–platelets (aMAP) risk score, an emerging non-invasive marker for liver fibrosis and hepatocellular carcinoma, has shown potential in risk stratification. However, its association with mortality in the broader population of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), MetALD, and Alcohol-related Liver Disease (ALD) remains unclear. Elucidating this relationship is crucial for healthcare and public health.MethodsWe performed a cohort study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. We used multivariable Cox proportional hazards models, Restricted cubic spline (RCS) analysis and Kaplan–Meier curves to assess the association between the aMAP score and all-cause, cardiovascular, and cancer mortality risks. The Fine-Grey competing risk analyses were used as a supplement. Mortality data were ascertained via the National Death Index through December 31, 2019. An independent hospital-based Southern Chinese cohort (n = 642) was additionally included for external validation of the association between aMAP score and MASLD.ResultsA total of 32,654 participants were included. The prevalence of MASLD, MetALD, and ALD was 41.14, 2.22, and 0.79%, respectively. RCS analysis revealed a non-linear relationship between aMAP and all-cause mortality in all SLD subclassifications. Kaplan–Meier curves confirmed significantly lower survival rates in participants with higher aMAP scores. After multivariable adjustment, the high aMAP risk group (>60) had a significantly higher risk of all-cause, cardiovascular, and cancer mortality in most SLD classifications. This association remained robust in subgroup analyses for MASLD (HR: 1.11), MetALD (HR: 1.39), and ALD (HR: 1.87) on all-cause mortality. In the external validation cohort, elevated aMAP scores were also associated with higher odds of MASLD, showing an overall positive and approximately linear relationship. External validation demonstrated the linear association between aMAP and MASLD.ConclusionThe aMAP score is independently associated with long-term mortality risk across the whole subgroup of steatotic liver disease. As a readily available and effective risk-stratification tool, the aMAP stratification can help identify high-risk individuals within all SLD subclassifications and support clinical application and resource allocation. The association of aMAP with prevalence of MASLD was further supported by findings from an independent hospital-based validation cohort.