Hepatology communications · 2026
Two-step care pathways for advanced MASLD in primary and hospital care: A multicenter study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Driessen Stan, van Son Koen C, Riemersma Tamara R, Stramigioli Emily, Haverkamp Gerlinde L G, Denters Maaike J, Alblas Gabrielle, Tjwa Eric T T L, Hanssen Nordin M J, Pinto-Sietsma Sara-Joan, Vali Yasaman, Hamer Henrike M, van Kleef Laurens A, Leeming Diana J, Lønsmann Ida, Karsdal Morten A, Castro Cabezas Manuel, Takkenberg R Bart, Brouwer Willem P, Schers Henk J, Nieuwdorp Max, Drenth Joost P H, Tushuizen Maarten E, Holleboom Adriaan G
Аннотация
BACKGROUND: Early diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) fibrosis may prevent liver-related morbidity and mortality. We investigated the effectiveness of multiple 2-step approaches for detecting at-risk advanced MASLD fibrosis, defined as a hierarchical clinical score comprising liver histology and VCTE depending on availability, in primary and hospital outpatient care.
METHODS: Patients at risk for MASLD were recruited from general practices and regional and tertiary internal medicine clinics, after excluding other liver diseases. Simultaneous measurement of non-invasive tests (NITs), including fibrosis-4 score (FIB4), metabolic dysfunction-associated fibrosis-5 score (MAF5), NAFLD fibrosis score (NFS), enhanced liver fibrosis (ELF) test, procollagen type III N-terminal propeptide (PRO-C3), procollagen type VI N-terminal propeptide (PRO-C6), and vibration-controlled transient elastography (VCTE), allowed testing of 2-step referral pathways. Referral patterns were compared with regular care between 2016 and 2024 using a predefined reference standard.
RESULTS: Among 595 participants, 9.4% were at-risk of advanced MASLD fibrosis. A care pathway consisting of FIB4 (≥1.30) followed by VCTE yielded the greatest improvement, increasing the correct referral rate 5.0-fold (95% CI: 2.4-10.1) compared with regular care. However, care pathways incorporating MAF5 (≥1.0) or NFS (≥-1.455) followed by VCTE demonstrated markedly higher sensitivity at comparable increases in detection (both >4.5-fold). Among other second-step NITs, PRO-C3 outperformed ELF, PRO-C6, and ADAPT, resulting in a 2.2-fold (95% CI: 1.1-4.4) increase in correct referrals when used after FIB4 (≥1.30).
CONCLUSION: Two-step care pathways substantially improve the detection of at-risk advanced MASLD fibrosis across care settings. Pathways using FIB4, MAF5, or NFS followed by VCTE offer the best performance overall, while PRO-C3 is the most effective alternative blood-based second-step test.
METHODS: Patients at risk for MASLD were recruited from general practices and regional and tertiary internal medicine clinics, after excluding other liver diseases. Simultaneous measurement of non-invasive tests (NITs), including fibrosis-4 score (FIB4), metabolic dysfunction-associated fibrosis-5 score (MAF5), NAFLD fibrosis score (NFS), enhanced liver fibrosis (ELF) test, procollagen type III N-terminal propeptide (PRO-C3), procollagen type VI N-terminal propeptide (PRO-C6), and vibration-controlled transient elastography (VCTE), allowed testing of 2-step referral pathways. Referral patterns were compared with regular care between 2016 and 2024 using a predefined reference standard.
RESULTS: Among 595 participants, 9.4% were at-risk of advanced MASLD fibrosis. A care pathway consisting of FIB4 (≥1.30) followed by VCTE yielded the greatest improvement, increasing the correct referral rate 5.0-fold (95% CI: 2.4-10.1) compared with regular care. However, care pathways incorporating MAF5 (≥1.0) or NFS (≥-1.455) followed by VCTE demonstrated markedly higher sensitivity at comparable increases in detection (both >4.5-fold). Among other second-step NITs, PRO-C3 outperformed ELF, PRO-C6, and ADAPT, resulting in a 2.2-fold (95% CI: 1.1-4.4) increase in correct referrals when used after FIB4 (≥1.30).
CONCLUSION: Two-step care pathways substantially improve the detection of at-risk advanced MASLD fibrosis across care settings. Pathways using FIB4, MAF5, or NFS followed by VCTE offer the best performance overall, while PRO-C3 is the most effective alternative blood-based second-step test.