Evidence map›Paper›PMID 42748409›Full record

ArticleHepatology communications2026

Mild alkaline phosphatase elevation associates with increased mortality and major adverse liver outcomes in MASLD.

Jingyi Hu, Christopher Okarski, Pooja Rangan, Blake Czapla, Kira Zhao, Ethan Grey, Suranjan Bantupalli, Leanne Nasser, Majd Aboona, Karn Wijarnpreecha and 1 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Hepatology communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jingyi HuDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Christopher OkarskiDepartment of Statistics, University of Michigan, Ann Arbor, Michigan, USA.
Pooja RanganDivision of Clinical Data Analytics and Decision Support, Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Blake CzaplaDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Kira ZhaoDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Ethan GreyDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Suranjan BantupalliDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Leanne NasserDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Majd AboonaDepartment of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Karn WijarnpreechaDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Vincent L ChenDivision of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Funding

Predictive models for incident cirrhosis in non-alcoholic fatty liver disease using genetic and electronic medical record-based risk factorsK08DK132312 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Vincent Lingzhi Chen · 2022 to 2026
$834k
NIDDK NIH HHS K08 DK132312
6 · The paper itself

Abstract

backgroundAlkaline phosphatase (ALP) elevation is commonly observed in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), but its clinical implications in MASLD are unclear. We evaluated whether longitudinal patterns of mild ALP elevation are associated with mortality and major adverse liver outcomes (MALO).

methodsWe performed a multicenter retrospective cohort study of adults with MASLD from Michigan Medicine and the Banner Health system. We included patients with MASLD defined as hepatic steatosis on imaging and at least one cardiometabolic comorbidity, with at least 1 ALP measurement within 1 year of the imaging date. Mild ALP elevation was defined as >1 to ≤1.5× the upper limit of normal and categorized as persistently normal, transiently elevated, or persistently elevated. Primary outcomes were all-cause mortality and MALO. Mortality was modeled as a Cox proportional hazards model, and MALO as Fine-Gray competing risk models.

resultsAmong 32,753 patients, persistently elevated ALP was present in ~10% of both cohorts. After multivariable adjustment, persistently elevated ALP was associated with increased mortality and MALO in both Michigan (mortality HR 1.51, 95% CI 1.20-1.89; MALO SHR 2.45, 95% CI 1.55-3.88) and Banner (mortality HR 1.81, 95% CI 1.19-2.75; MALO SHR 2.13, 95% CI 1.55-2.94). Associations were most consistent in low-risk and intermediate-risk FIB-4 groups. Associations remained significant in sensitivity analyses excluding baseline cirrhosis and restricting to patients with at least 2 ALP measurements.

conclusionsPersistent ALP elevation was associated with increased risk of mortality and MALO in MASLD, particularly among patients with low-risk and intermediate-risk FIB-4 scores. These findings suggest that ALP may serve as a clinically meaningful biomarker in early MASLD.

Indexed as

Alkaline PhosphataseFatty LiverAdultAgedBiomarkersFemaleHumansMaleMichiganMiddle AgedProportional Hazards ModelsRetrospective StudiesAlkaline PhosphataseBiomarkersbiomarkersFIB-4hepatic decompensationprognosisrisk stratification

Identifiers

PMID42748409
PMCPMC13585302

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.