Risk of liver-related events in metabolic dysfunction-associated steatohepatitis (MASH) patients with fibrosis: A comparative analysis of various risk stratification criteria.

Pennisi, Grazia; Enea, Marco; Romero-Gomez, Manuel; Bugianesi, Elisabetta; Wai-Sun Wong, Vincent; Fracanzani, Anna Ludovica; de Ledinghen, Victor; George, Jacob; Berzigotti, Annalisa; Viganò, Mauro; Sebastiani, Giada; Cannella, Roberto; Delamarre, Adèle; Di Maria, Gabriele; Lange, Naomi F; Tulone, Adele; Di Marco, Vito; Cammà, Calogero; Petta, Salvatore (2024). Risk of liver-related events in metabolic dysfunction-associated steatohepatitis (MASH) patients with fibrosis: A comparative analysis of various risk stratification criteria. Hepatology, 79(4), pp. 912-925. Wiley 10.1097/HEP.0000000000000616

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BACKGROUND

International regulatory agencies recommend testing drug therapy for patients with noncirrhotic high-risk metabolic dysfunction-associated steatohepatitis (MASH) because they are at risk of liver-related events(LRE). We aimed to compare the risk of LRE in MASLD patients stratified for F2-F4 fibrosis and MASH.

METHODS

1938 consecutive patients with biopsy-proven MASLD were enrolled. High-risk MASH was defined as MASH with F2-F4 fibrosis. LSM was measured by transient elastography. LRE were recorded during follow-up. Cox multivariate models were used to assess the association between high-risk MASH or F2-F4 fibrosis without MASH, of LSM(≥8 or ≥10 Kpa) and of AGILE 3+ with LRE. The diagnostic performance for the prediction of LRE was assessed using the area under the receiver operating characteristic(AUROC) curves.

RESULTS

The observed 5-year actuarial rate of LRE was 0.4%,0.2%,5.1% and 6.6% in patients with F0-F1 fibrosis without MASH, F0-F1 fibrosis with MASH, F2-F4 fibrosis without MASH, and high-risk MASH, respectively. At multivariate Cox regression analysis using F0-F1 fibrosis without MASH as reference, both F2-F4 fibrosis without MASH (adjusted hazard ratio[aHR] 9.96) and high-risk MASH (aHR 10.14) were associated with LRE. In the 1074 patients with available LSM, LSM≥10 KPa(aHR 6.31) or AGILE 3+ >0.67 (aHR 27.45) independently predicted the development of LRE and had similarly acceptable 5-year AUROC to high-risk MASH and F2-F4 fibrosis(0.772,0.818,0.739, and 0.780, respectively).

CONCLUSIONS

The risk of LRE is similar in patients with high-risk MASH and with F2-F4 fibrosis without MASH. The use of LSM≥10 KPa or AGILE 3+ >0.67 could be an accurate option to identify MASLD patients worthy to be included in clinical trials.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine
UniBE Contributor:	Berzigotti, Annalisa, Lange, Naomi Franziska
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1527-3350
Publisher:	Wiley
Language:	English
Submitter:	Pubmed Import
Date Deposited:	09 Oct 2023 10:35
Last Modified:	20 Mar 2024 00:12
Publisher DOI:	10.1097/HEP.0000000000000616
PubMed ID:	37796137
URI:	https://boris.unibe.ch/id/eprint/186944