Loomba Rohit, Amangurbanova Maral, Bettencourt Ricki, Madamba Egbert, Siddiqi Harris, Richards Lisa, Behling Cynthia, Sirlin Claude B, Gottwald Mildred D, Feng Shibao, Margalit Maya, Huang Daniel Q
MASLD Research Center, University of California San Diego, La Jolla, California, USA
Division of Epidemiology, University of California, San Diego, California, USA.
Gut. 2024 Jul 11;73(8):1343-1349. doi: 10.1136/gutjnl-2023-331401.
Dynamic changes in non-invasive tests, such as changes in alanine aminotransferase (ALT) and MRI proton-density-fat-fraction (MRI-PDFF), may help to detect metabolic dysfunction-associated steatohepatitis (MASH) resolution, but a combination of non-invasive tests may be more accurate than either alone. We developed a novel non-invasive score, the MASH Resolution Index, to detect the histological resolution of MASH.
This study included a derivation cohort of 95 well-characterised adult participants (67% female) with biopsy-confirmed MASH who underwent contemporaneous laboratory testing, MRI-PDFF and liver biopsy at two time points. The primary objective was to develop a non-invasive score to detect MASH resolution with no worsening of fibrosis. The most predictive logistic regression model was selected based on the highest area under the receiver operating curve (AUC), and the lowest Akaike information criterion and Bayesian information criterion. The model was then externally validated in a distinct cohort of 163 participants with MASH from a clinical trial.
The median (IQR) age and body mass index were 55 (45-62) years and 32.0 (30-37) kg/m, respectively, in the derivation cohort. The most accurate model (MASH Resolution Index) included MRI-PDFF, ALT and aspartate aminotransferase. The index had an AUC of 0.81 (95% CI 0.69 to 0.93) for detecting MASH resolution in the derivation cohort. The score calibrated well and performed robustly in a distinct external validation cohort (AUC 0.83, 95% CI 0.76 to 0.91), and outperformed changes in ALT and MRI-PDFF.
The MASH Resolution Index may be a useful score to non-invasively identify MASH resolution.
非侵入性检测的动态变化，如丙氨酸氨基转移酶（ALT）和磁共振成像质子密度脂肪分数（MRI-PDFF）的变化，可能有助于检测代谢功能障碍相关脂肪性肝炎（MASH）的缓解情况，但联合使用非侵入性检测可能比单独使用更准确。我们开发了一种新的非侵入性评分系统——MASH缓解指数，以检测MASH的组织学缓解情况。
本研究纳入了一个推导队列，其中95名活检确诊为MASH的成年参与者（67%为女性）在两个时间点同时进行了实验室检测、MRI-PDFF和肝活检。主要目标是开发一种非侵入性评分系统，以检测MASH缓解且纤维化无恶化的情况。基于受试者工作特征曲线（AUC）下面积最大、赤池信息准则和贝叶斯信息准则最低，选择了最具预测性的逻辑回归模型。然后在一项临床试验中，对163名患有MASH的不同队列参与者进行了外部验证。
推导队列中，年龄中位数（IQR）为55（45 - 62）岁，体重指数为32.0（30 - 37）kg/m²。最准确的模型（MASH缓解指数）包括MRI-PDFF、ALT和天冬氨酸氨基转移酶。该指数在推导队列中检测MASH缓解的AUC为0.81（95%CI 0.69至0.93）。该评分校准良好，在不同的外部验证队列中表现稳健（AUC 0.83，95%CI 0.76至0.91），且优于ALT和MRI-PDFF的变化。
MASH缓解指数可能是一种用于非侵入性识别MASH缓解情况的有用评分系统。
