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Lookup NU author(s): Professor Quentin AnsteeORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 The Authors. Liver International published by John Wiley & Sons Ltd.Background & Aims: There is a need to reduce the screen failure rate (SFR) in metabolic dysfunction-associated steatohepatitis (MASH) clinical trials (MASH+F2-3; MASH+F4) and identify people with high-risk MASH (MASH+F2-4) in clinical practice. We aimed to evaluate non-invasive tests (NITs) screening approaches for these target conditions. 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.
Author(s): Mozes FE, Lee JA, Vali Y, Selvaraj EA, Jayaswal ANA, Boursier J, de Ledinghen V, Lupsor-Platon M, Yilmaz Y, Chan W-K, Mahadeva S, Karlas T, Wiegand J, Shalimar, Tsochatzis E, Liguori A, Wong VW-S, Lee DH, Holleboom AG, van Dijk A-M, Mak AL, Hagstrom H, Akbari C, Hirooka M, Lee DH, Kim W, Okanoue T, Shima T, Nakajima A, Yoneda M, Thuluvath PJ, Li F, Berzigotti A, Mendoza YP, Noureddin M, Truong E, Fournier-Poizat C, Geier A, Tuthill T, Yunis C, Anstee QM, Harrison SA, Bossuyt PM, Pavlides M
Publication type: Article
Publication status: Published
Journal: Liver International
Year: 2024
Volume: 44
Issue: 8
Pages: 1872-1885
Print publication date: 01/08/2024
Online publication date: 04/04/2024
Acceptance date: 17/03/2024
Date deposited: 18/04/2024
ISSN (print): 1478-3223
ISSN (electronic): 1478-3231
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/liv.15914
DOI: 10.1111/liv.15914
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