Diagnostic accuracy of non-invasive tests to screen for at-risk MASH-An individual participant data meta-analysis.
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Mózes Ferenc E, Lee Jenny A, Vali Yasaman, Selvaraj Emmanuel A, Jayaswal Arjun N A, Boursier Jérôme, de Lédinghen Victor, Lupșor-Platon Monica, Yilmaz Yusuf, Chan Wah-Kheong, Mahadeva Sanjiv, Karlas Thomas, Wiegand Johannes, Shalimar, Tsochatzis Emmanouil, Liguori Antonio, Wong Vincent Wai-Sun, Lee Dae Ho, Holleboom Adriaan G, van Dijk Anne-Marieke, Mak Anne Linde, Hagström Hannes, Akbari Camilla, Hirooka Masashi, Lee Dong Hyeon, Kim Won, Okanoue Takeshi, Shima Toshihide, Nakajima Atsushi, Yoneda Masato, Thuluvath Paul J, Li Feng, Berzigotti Annalisa, Mendoza Yuly P, Noureddin Mazen, Truong Emily, Fournier-Poizat Céline, Geier Andreas, Tuthill Theresa, Yunis Carla, Anstee Quentin M, Harrison Stephen A, Bossuyt Patrick M, Pavlides Michael
Аннотация
METHODS: This was an individual participant data meta-analysis for the performance of NITs against liver biopsy for MASH+F2-4, MASH+F2-3 and MASH+F4. Index tests were the FibroScan-AST (FAST) score, liver stiffness measured using vibration-controlled transient elastography (LSM-VCTE), the fibrosis-4 score (FIB-4) and the NAFLD fibrosis score (NFS). Area under the receiver operating characteristics curve (AUROC) and thresholds including those that achieved 34% SFR were reported.
RESULTS: We included 2281 unique cases. The prevalence of MASH+F2-4, MASH+F2-3 and MASH+F4 was 31%, 24% and 7%, respectively. Area under the receiver operating characteristics curves for MASH+F2-4 were .78, .75, .68 and .57 for FAST, LSM-VCTE, FIB-4 and NFS. Area under the receiver operating characteristics curves for MASH+F2-3 were .73, .67, .60, .58 for FAST, LSM-VCTE, FIB-4 and NFS. Area under the receiver operating characteristics curves for MASH+F4 were .79, .84, .81, .76 for FAST, LSM-VCTE, FIB-4 and NFS. The sequential combination of FIB-4 and LSM-VCTE for the detection of MASH+F2-3 with threshold of .7 and 3.48, and 5.9 and 20 kPa achieved SFR of 67% and sensitivity of 60%, detecting 15 true positive cases from a theoretical group of 100 participants at the prevalence of 24%.
CONCLUSIONS: Sequential combinations of NITs do not compromise diagnostic performance and may reduce resource utilisation through the need of fewer LSM-VCTE examinations.