Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2024; 30(18): 2440-2453
Published online May 14, 2024. doi: 10.3748/wjg.v30.i18.2440
FibroScan-aspartate transaminase: A superior non-invasive model for diagnosing high-risk metabolic dysfunction-associated steatohepatitis
Jing-Ya Yin, Tian-Yuan Yang, Bing-Qing Yang, Chen-Xue Hou, Jun-Nan Li, Yue Li, Qi Wang
Jing-Ya Yin, Tian-Yuan Yang, Bing-Qing Yang, Qi Wang, Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Chen-Xue Hou, Yue Li, Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Jun-Nan Li, Beijing institute of infectious disease, Beijing 100015, China
Yue Li, Qi Wang, Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Author contributions: Yin JY and Yang TY contributed equally to this work; Wang Q and Li Y provided idea for this research and were co-corresponding authors; Yin JY, Yang TY, Yang BQ, Hou CX and Li Y critically revised the manuscript; Yin JY, Yang TY and Wang Q wrote the manuscript and performed the statistical analyses; Li JN performed a rigorous biostatistical review of the statistical methods presented in the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82170591; and Natural Science Foundation of Beijing, No. 7222097.
Institutional review board statement: The study was reviewed and approved by the Beijing Ditan Hospital, Capital Medical University Institutional Review Board.
Informed consent statement: This is a retrospective study, and informed consent is waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data collected during the study are available from the corresponding author at wangqidl04@ccmu.edu.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Wang, MD, PhD, Associate Professor, Associate Research Scientist, Chief Physician, Doctor, Teacher, Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100015, China. wangqidl04@ccmu.edu.cn
Received: January 15, 2024
Revised: March 19, 2024
Accepted: April 25, 2024
Published online: May 14, 2024
Processing time: 116 Days and 22.3 Hours
Abstract
BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) with hepatic histological NAFLD activity score ≥ 4 and fibrosis stage F ≥ 2 is regarded as “at risk” non-alcoholic steatohepatitis (NASH). Based on an international consensus, NAFLD and NASH were renamed as metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), respectively; hence, we introduced the term “high-risk MASH”. Diagnostic values of seven non-invasive models, including FibroScan-aspartate transaminase (FAST), fibrosis-4 (FIB-4), aspartate transaminase to platelet ratio index (APRI), etc. for high-risk MASH have rarely been studied and compared in MASLD.

AIM

To assess the clinical value of seven non-invasive models as alternatives to liver biopsy for diagnosing high-risk MASH.

METHODS

A retrospective analysis was conducted on 309 patients diagnosed with NAFLD via liver biopsy at Beijing Ditan Hospital, between January 2012 and December 2020. After screening for MASLD and the exclusion criteria, 279 patients were included and categorized into high-risk and non-high-risk MASH groups. Utilizing threshold values of each model, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV), were calculated. Receiver operating characteristic curves were constructed to evaluate their diagnostic efficacy based on the area under the curve (AUROC).

RESULTS

MASLD diagnostic criteria were met by 99.4% patients with NAFLD. The MASLD population was analyzed in two cohorts: Overall population (279 patients) and the subgroup (117 patients) who underwent liver transient elastography (FibroScan). In the overall population, FIB-4 showed better diagnostic efficacy and higher PPV, with sensitivity, specificity, PPV, NPV, and AUROC of 26.9%, 95.2%, 73.5%, 72.2%, and 0.75. APRI, Forns index, and aspartate transaminase to alanine transaminase ratio (ARR) showed moderate diagnostic efficacy, whereas S index and gamma-glutamyl transpeptidase to platelet ratio (GPR) were relatively weaker. In the subgroup, FAST had the highest diagnostic efficacy, its sensitivity, specificity, PPV, NPV, and AUROC were 44.2%, 92.3%, 82.1%, 67.4%, and 0.82. The FIB-4 AUROC was 0.76. S index and GPR exhibited almost no diagnostic value for high-risk MASH.

CONCLUSION

FAST and FIB-4 could replace liver biopsy as more effectively diagnostic methods for high-risk MASH compared to APRI, Forns index, ARR, S index, and GPR; FAST is superior to FIB-4.

Keywords: Metabolic dysfunction-associated steatotic liver disease; High-risk metabolic dysfunction-associated steatohepatitis; Non-invasive models; Liver biopsy; Diagnostic value

Core Tip: Patients with high-risk metabolic dysfunction-associated steatohepatitis (MASH) are more likely to develop cirrhosis or hepatocellular carcinoma. Early diagnosis, particularly without a liver biopsy, presents significant challenges. Exploring non-invasive models may increase detection efficiency. Although metabolic dysfunction-associated steatotic liver disease originates from non-alcoholic fatty liver disease, patient cohorts do not entirely overlap. Our study validated the concordance between these two distinct populations. To determine the effective replacement of liver biopsy with non-invasive models for diagnosing high-risk MASH, we utilized existing data to select seven diagnostic methods and assessed their diagnostic value for high-risk MASH.