Malandris Konstantinos, Arampidis Dimitrios, Mainou Maria, Papadopoulos Nikolaos, Karagiannis Thomas, Nayfeh Tarek, Liakos Aris, Sinakos Emmanouil, Tsapas Apostolos, Bekiari Eleni
Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Gastroenterol Hepatol. 2024 Dec;39(12):2582-2591. doi: 10.1111/jgh.16770. Epub 2024 Oct 12.
Following the approval of the first agent for the management of metabolic dysfunction-associated steatohepatitis (MASH), identification of patients with fibrotic MASH (MASH with NAS ≥ 4 and fibrosis stage ≥ 2) is crucial. We assessed the performance of FibroScan-aspartate aminotransferase (AST) score (FAST) for ruling in/out fibrotic MASH.
We searched Medline, Cochrane Library, Web of Science, Scopus, and gray literature sources up to January 11, 2024. Studies were eligible if they assessed the accuracy of FAST score for the detection of fibrotic MASH using biopsy as the reference standard at previously reported thresholds (FAST ≥ 0.67 for ruling-in and ≤ 0.35 for ruling-out fibrotic MASH). We calculated pooled sensitivity and specificity estimates for FAST thresholds alongside 95% confidence intervals following bivariate random- effects models. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework.
We included 16 studies with 8838 participants. A FAST score ≥ 0.67 yielded a pooled specificity of 0.87 (0.82-0.90) while a FAST score ≤ 0.35 yielded a summary sensitivity of 0.88 (0.83-0.91). At a prevalence of 30%, the positive predictive value for ruling-in fibrotic MASH was 60% while the negative predictive value for ruling-out the target condition was 91%. AST levels, cirrhosis prevalence, and number of pathologists reviewing biopsies were sources of heterogeneity among studies. The certainty of evidence was low to very low.
FAST score can be used as a triage test for ruling out fibrotic MASH. Nevertheless, its low positive predictive value necessitates sequential testing for ruling-in fibrotic MASH.
随着首个用于治疗代谢功能障碍相关脂肪性肝炎（MASH）的药物获批，识别纤维化MASH患者（NAS≥4且纤维化分期≥2的MASH）至关重要。我们评估了FibroScan-天冬氨酸转氨酶（AST）评分（FAST）用于诊断/排除纤维化MASH的性能。
我们检索了截至2024年1月11日的Medline、Cochrane图书馆、科学网、Scopus和灰色文献来源。如果研究使用活检作为参考标准，在先前报告的阈值（诊断纤维化MASH的FAST≥0.67，排除纤维化MASH的FAST≤0.35）下评估FAST评分检测纤维化MASH的准确性，则这些研究符合条件。我们采用双变量随机效应模型计算FAST阈值的合并敏感性和特异性估计值以及95%置信区间。我们使用推荐分级评估、制定和评价框架评估证据的确定性。
我们纳入了16项研究，共8838名参与者。FAST评分≥0.67时，合并特异性为0.87（0.82 - 0.90）；FAST评分≤0.35时，汇总敏感性为0.88（0.83 - 0.91）。在患病率为30%时，诊断纤维化MASH的阳性预测值为60%，排除目标疾病的阴性预测值为91%。AST水平、肝硬化患病率以及审查活检的病理学家数量是各研究间异质性的来源。证据的确定性为低至极低。
FAST评分可作为排除纤维化MASH的分诊检测方法。然而，其较低的阳性预测值需要进行序贯检测以诊断纤维化MASH。
