Tincopa Monica A, Díaz Luis Antonio, Huang Daniel Q, Arab Juan Pablo, Arrese Marco, Gadano Adrian, Oliveira Claudia P, Bettencourt Richele, Madamba Egbert, Kim Susy, Siddiqi Harris, Barreyro Fernando Javier, Marciano Sebastián, Martínez Morales Jorge, Villela-Nogueira Cristiane, Leite Nathalie, Couto Claudia Alves, Theodoro Rafael, Joyner de Sousa Dias Monteiro Mísia, Pessoa Mario G, Alvares-da-Silva Mario Reis, Higuera de la Tijera Fatima, Sabate Constanza D, Mendizabal Manuel, Richards Lisa, Sirlin Claude B, Loomba Rohit
MASLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Hepatology. 2025 Jun 1;81(6):1792-1804. doi: 10.1097/HEP.0000000000001121. Epub 2024 Oct 18.
Cut-points for noninvasive tests for risk stratification in metabolic dysfunction-associated steatotic liver disease were derived from predominantly non-Hispanic populations. It is unknown if these cut-points perform adequately in Hispanic individuals. We assessed the performance characteristics of current noninvasive test cut-points among Hispanic patients and determined whether they could be further optimized.
We prospectively enrolled 244 adults with biopsy-proven metabolic dysfunction-associated steatotic liver disease. Participants underwent a research visit with magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE). Histology and imaging assessments were conducted centrally. Diagnostic performance was evaluated by AUROC and optimal cut-points were identified by Youden J analysis. The mean (±SD) age and body mass index were 52.6 (±13) and 31.6 (±4.6) kg/m 2 . Overall, 40% had diabetes, and 31% (N = 75) were Hispanic. Forty percent of Hispanic and 28.4% of non-Hispanic patients had significant fibrosis. To detect significant fibrosis, MRE and VCTE exhibited significantly lower accuracy in Hispanic versus non-Hispanic participants (AUROC: MRE, 0.87 vs. 0.98, p = 0.01; VCTE, 0.78 vs. 0.92, p = 0.02). Clinical care algorithms yielded high false-negative rates among Hispanic participants (14% with low-risk fibrosis-4 index and 21% with low-risk VCTE had advanced fibrosis on biopsy). Cut-points of 2.73 kPa for MRE and 6.9 kPa for VCTE were optimal for detecting significant fibrosis in Hispanic individuals. Findings were validated in a Latin American cohort.
Lower noninvasive test cut-points may be needed to optimize surveillance for significant fibrosis due to metabolic dysfunction-associated steatotic liver disease in Hispanic populations commensurate with their higher burden and severity of disease.
代谢功能障碍相关脂肪性肝病风险分层的非侵入性检测切点主要源自非西班牙裔人群。尚不清楚这些切点在西班牙裔个体中是否适用。我们评估了当前非侵入性检测切点在西班牙裔患者中的性能特征，并确定它们是否可以进一步优化。
我们前瞻性纳入了244例经活检证实为代谢功能障碍相关脂肪性肝病的成年人。参与者接受了磁共振弹性成像（MRE）和振动控制瞬时弹性成像（VCTE）的研究性检查。组织学和影像学评估在中心进行。通过受试者工作特征曲线下面积（AUROC）评估诊断性能，并通过约登指数分析确定最佳切点。平均（±标准差）年龄和体重指数分别为52.6（±13）岁和31.6（±4.6）kg/m²。总体而言，40%患有糖尿病，31%（n = 75）为西班牙裔。40%的西班牙裔患者和28.4%的非西班牙裔患者有显著纤维化。为检测显著纤维化，MRE和VCTE在西班牙裔参与者中的准确性显著低于非西班牙裔参与者（AUROC：MRE，0.87对0.98，p = 0.01；VCTE，0.78对0.92，p = 0.02）。临床护理算法在西班牙裔参与者中产生了较高的假阴性率（低风险纤维化-4指数者中有14%以及低风险VCTE者中有21%在活检时存在晚期纤维化）。MRE的切点为2.73 kPa，VCTE的切点为6.9 kPa，对检测西班牙裔个体中的显著纤维化最为合适。研究结果在拉丁美洲队列中得到验证。
由于西班牙裔人群代谢功能障碍相关脂肪性肝病的疾病负担和严重程度较高，可能需要较低的非侵入性检测切点来优化对显著纤维化的监测。
