Canivet Clémence Marie, Ongaro Marie, Conquet Nicolas, Spahr Laurent, Goossens Nicolas
Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland.
Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland.
Gastro Hep Adv. 2025 Jul 10;4(10):100747. doi: 10.1016/j.gastha.2025.100747. eCollection 2025.
Multistep algorithms for noninvasive identification of patients with metabolic dysfunction-associated steatotic liver disease (MASLD), such as the recent American Association for the Study of Liver Disease and European Association for the Study of the Liver MASLD guidelines aim to identify patients who require hepatology referral. We evaluated the performance of these algorithms in the National Health and Nutrition Examination Survey cohort.
We analyzed 7768 adult participants from the National Health and Nutrition Examination Survey 2017-2020 with valid liver stiffness measurement (LSM) data. MASLD was defined as hepatic steatosis (controlled attenuation parameter measurement of ≥ 248 dB/m) with ≥1 cardiometabolic risk factor; significant fibrosis and advanced fibrosis were defined as LSM ≥8 kPa and ≥12 kPa respectively (with sensitivity analysis of 0-30kPa and using the FibroScan-aspartate aminotransferase or Agile algorithms).
A total of 44.8% (n = 3479) met metabolic risk criteria, 7.5% (n = 586) met raised Fibrosis-4 Index criteria, and 3.0% (n = 235) met referral criteria. The multistep pathway demonstrated high specificity but limited sensitivity for identifying MASLD with significant fibrosis (sensitivity 21%, 95% confidence interval [CI] 17%-25%) or advanced fibrosis (29%, 95% CI 23%-37%). Sensitivity was particularly low in key subgroups: age < 50 years (6%, 95% CI 3%-11%), women (15%, 95% CI 11%-21%) and patients without type 2 diabetes (16%, 95% CI 12%-20%). Sensitivity improved when targeting more advanced disease: 29% for advanced fibrosis (LSM ≥12 kPa), 54% for FibroScan-aspartate aminotransferase ≥0.67, 35% for Agile 3+ ≥0.68, and 66% for Agile 4 ≥ 0.57.
A multistep screening strategy based on metabolic risk criteria, Fibrosis-4 Index, and LSM demonstrates high specificity but low sensitivity for detecting MASLD with significant fibrosis in a US-based populational cohort.
用于非侵入性识别代谢功能障碍相关脂肪性肝病（MASLD）患者的多步骤算法，如最近美国肝病研究协会和欧洲肝病研究协会的MASLD指南，旨在识别需要肝病专科转诊的患者。我们在国家健康与营养检查调查队列中评估了这些算法的性能。
我们分析了2017 - 2020年国家健康与营养检查调查中的7768名成年参与者，他们有有效的肝脏硬度测量（LSM）数据。MASLD被定义为伴有≥1个心血管代谢危险因素的肝脂肪变性（控制衰减参数测量值≥248 dB/m）；显著纤维化和进展性纤维化分别定义为LSM≥8 kPa和≥12 kPa（进行了0 - 30kPa的敏感性分析，并使用FibroScan - 天冬氨酸转氨酶或Agile算法）。
共有44.8%（n = 3479）符合代谢风险标准，7.5%（n = 586）符合升高的Fibrosis - 4指数标准，3.0%（n = 235）符合转诊标准。多步骤途径在识别伴有显著纤维化（敏感性21%，95%置信区间[CI] 17% - 25%）或进展性纤维化（29%，95% CI 23% - 37%）的MASLD时显示出高特异性但有限的敏感性。在关键亚组中敏感性特别低：年龄<50岁（6%，95% CI 3% - 11%）、女性（15%，95% CI 11% - 21%）和无2型糖尿病患者（16%，95% CI 12% - 20%）。当针对更晚期疾病时敏感性提高：进展性纤维化（LSM≥12 kPa）为29%，FibroScan - 天冬氨酸转氨酶≥0.67为54%，Agile 3 +≥0.68为35%，Agile 4≥0.57为66%。
基于代谢风险标准、Fibrosis - 4指数和LSM的多步骤筛查策略在以美国为基础的人群队列中检测伴有显著纤维化的MASLD时显示出高特异性但低敏感性。
