Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD

Beom Kyung Kim¹, Nobuharu Tamaki², Kento Imajo³, Masato Yoneda⁴, Nancy Sutter⁵, Jinho Jung⁵, Tuo Lin⁶, Xin M Tu⁶, Jaclyn Bergstrom⁵, Khang Nguyen⁵, Leyna Nguyen⁵, Tracy Le⁵, Egbert Madamba⁵, Lisa Richards⁵, Mark A Valasek⁷, Cynthia Behling⁸, Claude B Sirlin⁹, Atsushi Nakajima⁴, Rohit Loomba¹⁰

Affiliations

¹ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
² NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
³ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan; Department of Gastroenterology, Shin-yurigaoka General Hospital, Kanagawa, Japan.
⁴ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
⁵ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States.
⁶ Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States.
⁷ Department of Pathology, University of California San Diego, La Jolla, CA, United States.
⁸ Sharp Medical Group, Department of Pathology, University of California San Diego, La Jolla, CA, United States.
⁹ Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, United States.
¹⁰ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States; Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States. Electronic address: roloomba@ucsd.edu.

PMID: 35973577
DOI: 10.1016/j.jhep.2022.07.020

Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD

Beom Kyung Kim et al. J Hepatol. 2022 Dec.

. 2022 Dec;77(6):1482-1490.

doi: 10.1016/j.jhep.2022.07.020. Epub 2022 Aug 13.

Authors

Affiliations

¹ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
² NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States; Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
³ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan; Department of Gastroenterology, Shin-yurigaoka General Hospital, Kanagawa, Japan.
⁴ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
⁵ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States.
⁶ Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States.
⁷ Department of Pathology, University of California San Diego, La Jolla, CA, United States.
⁸ Sharp Medical Group, Department of Pathology, University of California San Diego, La Jolla, CA, United States.
⁹ Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, United States.
¹⁰ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, United States; Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States. Electronic address: roloomba@ucsd.edu.

PMID: 35973577
DOI: 10.1016/j.jhep.2022.07.020

Abstract

Background & aims: Patients with non-alcoholic fatty liver disease (NAFLD) and significant fibrosis (fibrosis stage ≥2) are candidates for pharmacological trials. The aim of this study was to perform a head-to-head comparison of the diagnostic test characteristics of three non-invasive stiffness-based models including MEFIB (magnetic resonance elastography [MRE] plus FIB-4), MAST (magnetic resonance imaging [MRI]-aspartate aminotransferase [AST]), and FAST (FibroScan-AST) for detecting significant fibrosis.

Methods: This prospective study included 563 patients with biopsy-proven NAFLD undergoing contemporaneous MRE, MRI proton density fat fraction (MRI-PDFF) and FibroScan from two prospective cohorts derived from Southern California and Japan. Diagnostic performances of models were evaluated by area under the receiver-operating characteristic curve (AUC).

Results: The mean age of the cohort was 56.5 years (51% were women). Significant fibrosis was observed in 51.2%. To detect significant fibrosis, MEFIB outperformed both MAST and FAST (both p <0.001); AUCs for MEFIB, MAST, and FAST were 0.901 (95% CI 0.875-0.928), 0.770 (95% CI 0.730-0.810), and 0.725 (95% CI 0.683-0.767), respectively. Using rule-in criteria, the positive predictive value of MEFIB (95.3%) was significantly higher than that of FAST (83.5%, p = 0.001) and numerically but not statistically greater than that of MAST (90.0%, p = 0.056). Notably, MEFIB's rule-in criteria covered more of the study population than MAST (34.1% vs. 26.6%; p = 0.006). Using rule-out criteria, the negative predictive value of MEFIB (90.1%) was significantly higher than that of either MAST (69.6%) or FAST (71.8%) (both p <0.001). Furthermore, to diagnose "at risk" non-alcoholic steatohepatitis defined as NAFLD activity score ≥4 and fibrosis stage ≥2, MEFIB outperformed both MAST and FAST (both p <0.05); AUCs for MEFIB, MAST, and FAST were 0.768 (95% CI 0.728-0.808), 0.719 (95% CI 0.671-0.766), and 0.687 (95% CI 0.640-0.733), respectively.

Conclusions: MEFIB was better than MAST and FAST for detection of significant fibrosis as well as "at risk" NASH. All three models provide utility for the risk stratification of NAFLD.

Lay summary: Non-alcoholic fatty liver disease (NAFLD) affects over 25% of the general population worldwide and is one of the main causes of chronic liver disease. Because so many individuals have NAFLD, it is not practical to perform liver biopsies to identify those with more severe disease who may require pharmacological interventions. Therefore, accurate non-invasive tests are crucial. Herein, we compared three such tests and found that a test called MEFIB was the best at detecting patients who might require treatment.

Keywords: FAST; MAST; MEFIB; NAFLD; diagnosis; significant fibrosis; validation.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests Rohit Loomba serves as a consultant to Aardvark Therapeutics, Altimmune, Anylam/Regeneron, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Bristol-Myer Squibb, CohBar, Eli Lilly, Galmed, Gilead, Glympse bio, Hightide, Inipharma, Intercept, Inventiva, Ionis, Janssen Inc., Madrigal, Metacrine, Inc., NGM Biopharmaceuticals, Novartis, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, 89 bio, Terns Pharmaceuticals and Viking Therapeutics. In addition, his institutions received research grants from Arrowhead Pharmaceuticals, Astrazeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galectin Therapeutics, Galmed Pharmaceuticals, Gilead, Intercept, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, NGM Biopharmaceuticals, Novo Nordisk, Merck, Pfizer, Sonic Incytes and Terns Pharmaceuticals. Co-founder of LipoNexus Inc. Claude B. Sirlin reports grants from GE, Siemens, Philips, Bayer, Gilead; personal consultation fees from Blade, Boehringer, and Epigenomics; consultation under the auspices of the University to AMRA, BMS, Exact Sciences, GE Digital, and IBM-Watson; lab service agreements from Enanta, Gilead, ICON, Intercept, Nusirt, Shire, Synageva, Takeda; royalties or honoraria from Wolters Kluwer and Medscape, respectively, for educational material outside the submitted work. The other authors disclose no conflicts. Please refer to the accompanying ICMJE disclosure forms for further details.

Comment in

MEFIB vs. MAST and FAST: Not a competition but useful tools.
Noureddin M, Harrison SA, Alkhouri N. Noureddin M, et al. J Hepatol. 2024 Jan;80(1):e35-e36. doi: 10.1016/j.jhep.2022.10.020. Epub 2022 Nov 10. J Hepatol. 2024. PMID: 36370950 No abstract available.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD

Affiliations

Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources