acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study.
Feng G., Mózes FE., Ji D., Treeprasertsuk S., Okanoue T., Shima T., Liang H., Tsochatzis E., Chen J., Schattenberg JM., Labenz C., Mahadeva S., Chan WK., Chi X., Delamarre A., de Lédinghen V., Petta S., Bugianesi E., Hagström H., Boursier J., Calleja JL., Boon-Bee Goh G., Gallego-Durán R., Sanyal AJ., Fan J-G., Castéra L., Lai M., Harrison SA., Romero-Gomez M., Kim SU., Zhu Y., Ooi G., Shi J., Yoneda M., Nakajima A., Zhang J., Lupsor-Platon M., Zhong B., Cobbold JFL., Ye C-Y., Eddowes PJ., Newsome P., Li J., George J., He F., Song MJ., Tang H., Fan Y., Jia J., Xu L., Lin S., Li Y., Lu Z., Nan Y., Niu J., Yan X., Zhou Y., Liu C., Deng H., Ye Q., Zeng Q-L., Li L., Wang J., Yang S., Lin H., Lee HW., Cheuk-Fung Yip T., Fournier-Poizat C., Lai-Hung Wong G., Pennisi G., Armandi A., Liu W-Y., Shang Y., de Saint-Loup M., Llop E., Jun Teh KK., Romero CL., Asgharpour A., Mahgoub S., Sau-Wai Chan M., Canivet CM., Ji F., Xin Y., Chai J., Dong Z., Targher G., Byrne CD., He N., Mi M., Ye F., Wai-Sun Wong V., Pavlides M., Zheng M-H.
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.