ClinGastroenterolHepatol. 2024Oct1:S15423565(24)008632.doi:10.1016/j.cgh.2024.07.045. Online ahead of print.
Gong Feng 1, Ferenc E Mózes 2, Dong Ji 3, Sombat Treeprasertsuk 4, Takeshi Okanoue 5, Toshihide Shima 5, Huiqing Liang 6, Emmanuel Tsochatzis 7, Jinjun Chen 8, Jorn M Schattenberg 9, Christian Labenz 9, Sanjiv Mahadeva 10, Wah Kheong Chan 10, Xiaoling Chi 11, Adele Delamarre 12, Victor de Lédinghen 12, Salvatore Petta 13, Elisabetta Bugianesi 14, Hannes Hagström 15, Jerome Boursier 16, Jose Luis Calleja 17, George Boon-Bee Goh 18, Rocio Gallego-Durán 19, Arun J Sanyal 20, Jian-Gao Fan 21, Laurent Castéra 22, Michelle Lai 23, Stephen A Harrison 24, Manuel Romero-Gomez 19, Seung Up Kim 25, Yongfen Zhu 26, Geraldine Ooi 27, Junping Shi 28, Masato Yoneda 29, Atsushi Nakajima 29, Jing Zhang 30, Monica Lupsor-Platon 31, Bihui Zhong 32, Jeremy F L Cobbold 33, Chun-Yan Ye 34, Peter J Eddowes 35, Philip Newsome 36, Jie Li 37, Jacob George 38, Fangping He 39, Myeong Jun Song 40, Hong Tang 41, Yuchen Fan 42, Jidong Jia 43, Liang Xu 44, Su Lin 45, Yiling Li 46, Zhonghua Lu 47, Yuemin Nan 48, Junqi Niu 49, Xuebing Yan 50, Yongjian Zhou 51, Chenghai Liu 52, Hong Deng 53, Qing Ye 54, Qing-Lei Zeng 55, Lei Li 56, Jing Wang 57, Song Yang 58, Huapeng Lin 59, Hye Won Lee 25, Terry Cheuk-Fung Yip 59, Céline Fournier-Poizat 60, Grace Lai-Hung Wong 59, Grazia Pennisi
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Abstract
Background & aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).
Methods: We analyzed data from 3,004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and nine international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9,034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs.
Results: In the pooled global cohort, the acMASH index identified MASH with an AUROC of 0.802 (95%CI 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI 0.693-0.800, P<0.01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted-hazard ratio: 11.23 95%CI 3.98-31.66).
Conclusions: This multi-ethnic study validates the acMASH index as a reliable, non-invasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.
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