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Comparative Study
. 2024 May 14;30(18):2440-2453.
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  1 , Tian-Yuan Yang  1 , Bing-Qing Yang  1 , Chen-Xue Hou  2 , Jun-Nan Li  3 , Yue Li  2   4 , Qi Wang  1   5
Affiliations
Comparative Study

FibroScan-aspartate transaminase: A superior non-invasive model for diagnosing high-risk metabolic dysfunction-associated steatohepatitis

Jing-Ya Yin et al. World J Gastroenterol. .

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

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow diagram of patient selection process. NAFLD: Non-alcoholic fatty liver disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; LSM: Liver stiffness measurement; CAP: Controlled attenuation parameter; MASH: Metabolic dysfunction-associated steatohepatitis; NAS: Non-alcoholic fatty liver disease activity score.
Figure 2
Figure 2
The distribution of seven non-invasive models based on high threshold criteria. A: The distribution of non-invasive models in the overall population; B: The distribution of non-invasive models in the subgroup population. MASH: Metabolic dysfunction-associated steatohepatitis; FAST: FibroScan-aspartate transaminase; FIB-4: Fibrosis-4; APRI: Aspartate transaminase to platelet ratio index; ARR: Aspartate transaminase to alanine transaminase ratio; GPR: Gamma-glutamyl transpeptidase to platelet ratio.
Figure 3
Figure 3
The evaluation of seven non-invasive models by receiver operating characteristic curves. A: The receiver operating characteristic curves (ROC) of the overall population; B: The ROC of the subgroup population. FAST: FibroScan-aspartate transaminase; FIB-4: Fibrosis-4; APRI: Aspartate transaminase to platelet ratio index; ARR: Aspartate transaminase to alanine transaminase ratio; GPR: Gamma-glutamyl transpeptidase to platelet ratio.
See this image and copyright information in PMC

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