Journal of general internal medicine · 2025
Diagnosis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) at Risk for Advanced Fibrosis in a Real-World Primary Care Setting: A Cross-Sectional Study.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Schreiner Andrew D, Zhang Jingwen, Bolus Vincent, Marsden Justin, Bays Chloe, Mohamed Ahmed, Moran William P, Mauldin Patrick D, Gebregziabher Mulugeta, Rockey Don C
Аннотация
BACKGROUND: Recent guidelines provide recommendations for diagnosing metabolic dysfunction-associate steatotic liver disease (MASLD) when hepatic steatosis is seen radiographically, but questions remain as to when to pursue imaging for the evidence of hepatic steatosis.
OBJECTIVE: We aimed to test the performance of traditional MASLD case-finding cues for detecting MASLD at-risk for advanced fibrosis.
DESIGN: We performed a cross-sectional study of electronic health record data from a large primary care clinic between 2012 and 2021.
PATIENTS: Patients with abdominal imaging and inputs for Fibrosis-4 Index (FIB-4) calculation.
MAIN MEASURES: We examined the performance characteristics of type 2 diabetes mellitus (T2DM), a BMI ≥ 30 kg/m2, or an alanine aminotransferase (ALT) ≥ 40 IU/L for detecting the primary outcome of MASLD at-risk for advanced fibrosis. We also tested the optimal thresholds of BMI and ALT for detecting the primary outcome.
KEY RESULTS: The sample included 9000 patients of whom 1683 (19%) patients had MASLD and 696 (8%) had MASLD and an indeterminate-risk or greater for advanced fibrosis. T2DM, BMI ≥ 30 kg/m2, and ALT ≥ 40 IU/L identified 45%, 48%, and 49% of patients with MASLD at-risk for advanced fibrosis. An ALT ≥ 31 IU/L had the highest AUC for detecting MASLD at-risk for advanced fibrosis, and the union of T2DM, BMI ≥ 30 kg/m2, or ALT ≥ 31 IU/L had a sensitivity of 89%.
CONCLUSIONS: While historical cues for MASLD case finding had low sensitivities individually, the union of these three, simple, broadly available signals had a high sensitivity for MASLD at-risk for advanced fibrosis.
OBJECTIVE: We aimed to test the performance of traditional MASLD case-finding cues for detecting MASLD at-risk for advanced fibrosis.
DESIGN: We performed a cross-sectional study of electronic health record data from a large primary care clinic between 2012 and 2021.
PATIENTS: Patients with abdominal imaging and inputs for Fibrosis-4 Index (FIB-4) calculation.
MAIN MEASURES: We examined the performance characteristics of type 2 diabetes mellitus (T2DM), a BMI ≥ 30 kg/m2, or an alanine aminotransferase (ALT) ≥ 40 IU/L for detecting the primary outcome of MASLD at-risk for advanced fibrosis. We also tested the optimal thresholds of BMI and ALT for detecting the primary outcome.
KEY RESULTS: The sample included 9000 patients of whom 1683 (19%) patients had MASLD and 696 (8%) had MASLD and an indeterminate-risk or greater for advanced fibrosis. T2DM, BMI ≥ 30 kg/m2, and ALT ≥ 40 IU/L identified 45%, 48%, and 49% of patients with MASLD at-risk for advanced fibrosis. An ALT ≥ 31 IU/L had the highest AUC for detecting MASLD at-risk for advanced fibrosis, and the union of T2DM, BMI ≥ 30 kg/m2, or ALT ≥ 31 IU/L had a sensitivity of 89%.
CONCLUSIONS: While historical cues for MASLD case finding had low sensitivities individually, the union of these three, simple, broadly available signals had a high sensitivity for MASLD at-risk for advanced fibrosis.