Baseline data and related characteristics of the self-management scores for patients with MASLD

This study enrolled 255 patients with MASLD who met the inclusion and exclusion criteria, with 255 questionnaires distributed and 241 valid questionnaires finally collected, which constituted an effective response rate of 94.5%. There were 132 men and 109 women, with the majority (79.6%) aged 31–60 years. The majority (83.0%) were married, 145 (60.2%) had no smoking history, 159 (66.0%) had mild fatty liver, 190 (78.8%) had ≥ 1 type(s) of chronic diseases and 51.9% had a family history of MASLD. Table 1 summarises the baseline data of the enrolled patients.

Table 1 Baseline data and univariate analysis of self-management scores in MASLD patients (n = 241)Self-management scores of patients with MASLD

The average self-management score of the 241 patients was 91.24 ± 16.98 points, ranging from 60 to 130 points. The total scores for unhealthy lifestyle, psychological cognition management, disease prevention and treatment management, disease knowledge management, and daily life management were 15, 15, 55, 20 and 50 points, respectively, and the average patient scores were 10.45 ± 3.28, 9.69 ± 2.00, 32.42 ± 8.38, 11.44 ± 3.58 and 27.23 ± 6.23, respectively, with a scoring rate of 69.67%, 64.60%, 58.95%, 57.20% and 54.46%, respectively. The specific scores for each dimension are presented in Table 2. The level of self-management ability was low (< 60%) for 127 patients, medium (60–80%) for 108 patients and high (> 80%) for 6 patients, accounting for 52.7%, 44.8% and 2.5%, respectively.

Table 2 Self-management scores of MASLD patientsUnivariate analysis of the self-management ability of patients with MASLD

The result of univariate analysis showed patients over 50 years as well as those who were married, had a college degree or above, had commercial health insurance, had no smoking history, had severe fatty liver and had no concomitant chronic diseases had higher self-management scores than other age groups.

Factors associated with higher levels of self-management ability

The results of univariate analysis identified statistically significant differences (P < 0.05) in self-management scores among the patients with MASLD when these factors, including age, marital status, education level, medical payment method, smoking history, severity of fatty liver and number of comorbid chronic diseases (see Table 1), were considered as variables. When age was considered as a single factor, there were significant differences in scores across different age groups. Within the age range of 20–60 years, self-management scores tended to increase with age. The lowest self-management score was observed in the 20–30-years age group, with a mean of 83.84 ± 11.15, whereas the highest self-management score among the patients with MASLD was in the 51–60 age group, with a mean of 94.86 ± 18.39.

Married patients with MASLD demonstrated significantly higher levels of self-management ability than unmarried patients. When education level was considered as a single factor, self-management scores increased with higher levels of education (illiteracy, primary school, middle school and college degree or above). Notably, when household income was considered as a single factor, the lowest self-management scores were not observed in the lowest income bracket (< 1,000) but rather in the 1,000–3,000 income bracket. Non-smoking patients had significantly higher self-management scores than patients who smoked. When considering the severity of fatty liver or the number of comorbidities as single factors, self-management scores gradually decreased with the worsening severity of fatty liver or increased of number of concurrent chronic diseases.

Multivariate analysis of the self-management ability of patients with MASLD

Multiple linear regression analysis was performed using patients’ self-management score as the dependent variable and variables with statistically significant differences (see Table 1) as the independent variables. The assignment of independent variables is presented in Table 3, and the results of the multivariate analysis are summarised in Table 4. Four variables (marital status, education level, smoking history and severity of fatty liver) with statistical significance were included in the model for analysis, effectively explaining a 53.48% variability in the total self-management score of patients with MASLD (F = 21.549, P < 0.001). This study further clarified the degree to which each independent variable affected the patient’s self-management ability. Generally, the dependent variable with the larger absolute slope value had a greater impact on the dependent variable. Therefore, the factor with the greatest influence on the self-management ability of patients with MASLD was marital status (slope, 14.853), followed by smoking history (slope, − 12.085) and severity of fatty liver (slope, 4.313), with education level (slope, 2.458) having the least impact.

Table 3 Variable assignmentTable 4 Multiple linear regression analysis of self-management ability in MASLD patientsComparison of survival curves among three groups of patients

During the 1-year follow-up, among the 127 patients with low self-management ability, no loss to follow-up occurred, 23 patients were readmitted and 1 patient died of an unknown cause. Among the 108 patients with medium self-management ability, one patient was lost to follow-up and eight were readmitted. There were six patients with high self-management ability, with no loss to follow-up, no death and no readmission. The readmission rate for the low, medium and high self-management ability groups was 18.25% (excluding deaths), 7.48% (excluding deaths) and 0%, respectively. Using Kaplan–Meier to plot survival curves, the distribution of ‘survival’ among the three groups of patients was analysed using the log-rank test, with a statistically significant difference identified (χ2 = 6.824, P = 0.033). The survival curve of patients with low self-management ability was worse than that of the medium and high self-management ability groups (Fig. 1).

Fig. 1

Kaplan-Meier survival curves for three groups of MASLD patients

Univariate and multivariate Cox analysis of readmission in patients with MASLD

We conducted univariate Cox regression analysis on 12 factors affecting the readmission of patients with MASLD. The results indicated that the number of chronic diseases and self-management ability significantly influenced patient readmission (Table 5). These two variables were then included in a multivariate Cox regression using a stepwise approach. As shown in Table 6, having two or more chronic diseases had a more significant impact on readmission rates for MASLD. Additionally, an intermediate level of self-management ability had a more significant impact on readmission rates compared to a higher level.

Table 5 MASLD patients’ readmission Cox regression univariate analysis resultsTable 6 MASLD with COX regression multi-factor analysis result of readmission