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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).
© 2025 The Author(s). Liver International published by John Wiley & Sons Ltd.Background and Aims: The performance of non-invasive liver tests (NITs) is known to vary across settings and subgroups. We systematically evaluated whether the performance of three NITs in detecting advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) varies with age, sex, body mass index (BMI), type 2 diabetes mellitus (T2DM) status or liver enzymes. Methods: Data from 586 adult LITMUS Metacohort participants with histologically characterised MASLD were included. The diagnostic performance of the Fibrosis-4 Index (FIB-4), enhanced liver fibrosis (ELF) and vibration-controlled transient elastography liver stiffness measurement (VCTE LSM) was evaluated. Performance was expressed as the area under the receiver operating characteristics curve (AUC). Thresholds for detecting advanced fibrosis (≥F3) were calculated for each NIT for fixed (high) sensitivity, specificity and predictive values. Results: Differences in AUC between all subgroups were small and statistically not significant, indicating comparable performance in detecting ≥F3, irrespective of these clinical factors. However, different thresholds were needed to achieve the same level of accuracy with each test. For example, for a fixed sensitivity and specificity, the thresholds for all three NITs were higher in patients with T2DM. Effects for sex, age and liver enzymes were less pronounced. Conclusions: Performance of the selected NITs in detecting advanced liver fibrosis does not vary substantially with clinical characteristics. However, different thresholds have to be selected to achieve the same sensitivity, specificity and predictive values in the respective subgroups. Large prospective studies are called for to study NIT accuracy considering multiple patient characteristics.
Author(s): Vali Y, van Dijk A-M, Lee J, Boursier J, Ratziu V, Yunis C, Schattenberg JM, Valenti L, Gomez MR, Schuppan D, Petta S, Allison M, Hartman ML, Porthan K, Dufour J-F, Bugianesi E, Gastadelli A, Derdak Z, Fournier-Poizat C, Shumbayawonda E, Kalutkiewicz M, Yki-Jarvinen H, Ekstedt M, Geier A, Trylesinski A, Francque S, Brass C, Pavlides M, Holleboom AG, Nieuwdorp M, Anstee QM, Bossuyt PM
Publication type: Article
Publication status: Published
Journal: Liver International
Year: 2025
Volume: 45
Issue: 2
Print publication date: 01/02/2025
Online publication date: 24/01/2025
Acceptance date: 28/12/2024
Date deposited: 18/02/2025
ISSN (print): 1478-3223
ISSN (electronic): 1478-3231
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/liv.16240
DOI: 10.1111/liv.16240
Data Access Statement: At present, data from this study are not publicly available. The LITMUS study protocol has been published, including details of sample handling and processing, and includes an atlas of liver histology that may be used as a reference by pathologists. Patient level data will not be made available due to the various constraints imposed by ethics panels across all the different countries from which patients were recruited
PubMed id: 39865358
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