Creatinine clearance rate predicts all-cause and cardiovascular mortality in patients with MASLD: a Shanghai cohort study

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition globally, driving the need to identify prognostic risk factors. The creatinine clearance rate (CCR) serves as a sensitive early marker of glomerular filtration rate. Yet evidence regarding its specific association with mortality in MASLD patients remains limited. Method The predictive value of the CCR for long-term survival was evaluated in a five-year cohort of adults with MASLD from Pudong District, Shanghai. Baseline characteristics were analyzed, and Kaplan–Meier survival analysis, LASSO regression, restricted cubic splines (RCS), and Cox proportional hazards models were employed to assess the relationship between the CCR and mortality risk, with sensitivity analyses conducted to test robustness. Results Among 8,828 MASLD patients, a higher CCR was inversely associated with cardiovascular mortality (HR = 0.95; 95% CI: 0.95–0.96) and all-cause mortality (HR = 0.97; 95% CI: 0.96–0.97) (both P < 0.001). Compared to the lowest tertile (T1), the middle (T2) and highest (T3) tertiles showed lower risks ( P for trend < 0.05). RCS analysis revealed a non-linear correlation for both outcomes ( P for non-linearity < 0.05). Kaplan–Meier curves confirmed higher survival probabilities in the highest CCR tertile (log-rank P < 0.001). LASSO regression was used for variable selection and CCR was included in the multivariate prognostic model, suggesting that this index is valuable for model fitting and can serve as an auxiliary indicator for predicting mortality risk in patients with MASLD, which was supported by ROC analysis. Sensitivity analyses confirmed the stability of these findings. Conclusion In this cohort of Shanghai adults with MASLD, a higher estimated creatinine clearance rate was independently associated with a significantly reduced risk of all-cause and cardiovascular mortality. CCR may serve as a valuable renal function-related prognostic marker for risk stratification in the MASLD population.