Diagnostic Accuracy of Noninvasive Tests for Metabolic Dysfunction-Associated Steatotic Liver Disease Across Age, Type 2 Diabetes, and Obesity Subgroups: A Multinational Study.
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Younossi Zobair M, de Avila Leyla, Petta Salvatore, Hagström Hannes, Kim Seung Up, Nakajima Atsushi, Crespo Javier, Castera Laurent, Alkhouri Naim, Zheng Ming-Hua, Treeprasertsuk Sombat, Ananchuensook Prooksa, Shalimar, Tsochatzis Emmanuel, Trivikrama Shenoy Kotacherry, Balakumaran Leena Kondarappassery, Fan Jian-Gao, Roberts Stuart K, Alswat Khalid, Wai-Sun Wong Vincent, Yilmaz Yusuf, Dunn Winston, Francque Sven, Cordie Ahmed, Yu Ming-Lung, Ekstedt Mattias, Boon-Bee Goh George, Oliveira Claudia P, Pessoa Mario Guimaraes, Chan Wah Kheong, Castellanos Fernandez Marlen Ivon, Duseja Ajay, Arab Juan Pablo, Papatheodoridis George, Sebastiani Giada, Villela-Nogueira Cristiane, D'Ambrosio Roberta, Lampertico Pietro, AlNaamani Khalid M, Holleboom Adriaan G, Valsan Arun, Venu Arathi, El-Kassas Mohamed, Pennisi Grazia, Shang Ying, Liu Wen-Yue, Lee Hye Won, Kobayashi Takashi, Kakizaki Satoru, Caussy Cyrielle, Pearlman Brian, Iruzubieta Paula, Nadeem Rida, Cinque Felice, Neonaki Antonia, Zoncapé Mirko, Yang Rui-Xu, Song Sherlot Juan, Dunn Nicholas, Gadi Zouhir, Yeh Ming-Lun, Kim-Jun Teh Kevin, Mahadeva Sanjiv, Fabian Licet Gonzalez, Almohsen Ahmed, Leite Nathalie, Pugliese Nicola, Vessby Johan, Xie Chencheng, Choudhary Narendra Singh, Friend Ethan, Poca Maria, Kawaguchi Takumi, Russo Francesco Paolo, Gadano Adrian, Diaz Luis Antonio, Singal Ashwani K, Segrestin Berenice, Gunn Nadege, Mauricio Didac, Arrese Marco, Fracanzani Anna, Lombardi Rosa, Aghemo Alessio, Lam Brian, Racila Andrei, Alqahtani Saleh A, Stepanova Maria, Global NASH/MASH Council (GNC)
Аннотация
METHODS: We analyzed 18,759 adults with biopsy-confirmed MASLD from 41 countries. NITs included FIB-4, liver stiffness measurement (LSM), and Agile-3+. Diagnostic performance for advanced fibrosis (F3-F4) was measured using areas under the curve (AUCs) across subgroups defined by age, sex, type 2 diabetes (T2D), obesity, and alcohol use. Subgroup-specific cutoffs were derived.
RESULTS: Advanced fibrosis was present in 37% of patients. Pooled AUCs were 0.79 for FIB-4, 0.83 for LSM, and 0.86 for Agile-3+. FIB-4 accuracy declined with age (AUC 0.70 in ≥65 years vs 0.79 in <65 years, P < .0001) and in middle-aged patients with T2D. The LSM performance remained stable across T2D status but was moderately reduced in patients with obesity and, more profoundly, morbid obesity (body mass index [BMI] >35 kg/m2). Sex and alcohol use had minimal impact on AUCs. Age- and T2D-specific FIB-4 cutoffs varied substantially to maintain predefined accuracy (sensitivity or specificity). The cutoffs for LSM also differed based on patients' BMI, with lower diagnostic cutoffs for advanced fibrosis required in nonobese MASLD (sensitivity 80%: 8.8 kPa in lean, 9.0 kPa overweight, 9.6 kPa in obesity, 11.0 kPa in morbid obesity).
CONCLUSIONS: Accuracy of NITs for advanced fibrosis in MASLD is influenced by age, T2D, and obesity. Age-adjusted FIB-4 thresholds may enhance risk stratification. Imaging-based and composite NITs (LSM and Agile-3+) provide more consistent performance across MASLD subpopulations.