Strikingly, low hepatic FXR regulon activity and high expression of COL4A1 and COL4A2 were associated with increased rates of hepatic decompensation (Figures 3C, D) and higher overall mortality (Supplemental Figures S4F, G, http://links.lww.com/HC9/B86) in patients with MASLD. This evidence concerns the gene COL4A1 and metabolic dysfunction-associated steatotic liver disease.