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Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD

Authors
 Beom Kyung Kim  ;  Nobuharu Tamaki  ;  Kento Imajo  ;  Masato Yoneda  ;  Nancy Sutter  ;  Jinho Jung  ;  Tuo Lin  ;  Xin M Tu  ;  Jaclyn Bergstrom  ;  Khang Nguyen  ;  Leyna Nguyen  ;  Tracy Le  ;  Egbert Madamba  ;  Lisa Richards  ;  Mark A Valasek  ;  Cynthia Behling  ;  Claude B Sirlin  ;  Atsushi Nakajima  ;  Rohit Loomba 
Citation
 JOURNAL OF HEPATOLOGY, Vol.77(6) : 1482-1490, 2022-12 
Journal Title
JOURNAL OF HEPATOLOGY
ISSN
 0168-8278 
Issue Date
2022-12
MeSH
Aspartate Aminotransferases ; Elasticity Imaging Techniques* ; Female ; Fibrosis ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease* / diagnosis ; Prospective Studies
Keywords
FAST ; MAST ; MEFIB ; NAFLD ; diagnosis ; significant fibrosis ; validation
Abstract
Background & aims: Patients with non-alcoholic fatty liver disease (NAFLD) and significant fibrosis (fibrosis stage ≥2) are candidates for pharmacological trials. The aim of this study was to perform a head-to-head comparison of the diagnostic test characteristics of three non-invasive stiffness-based models including MEFIB (magnetic resonance elastography [MRE] plus FIB-4), MAST (magnetic resonance imaging [MRI]-aspartate aminotransferase [AST]), and FAST (FibroScan-AST) for detecting significant fibrosis.

Methods: This prospective study included 563 patients with biopsy-proven NAFLD undergoing contemporaneous MRE, MRI proton density fat fraction (MRI-PDFF) and FibroScan from two prospective cohorts derived from Southern California and Japan. Diagnostic performances of models were evaluated by area under the receiver-operating characteristic curve (AUC).

Results: The mean age of the cohort was 56.5 years (51% were women). Significant fibrosis was observed in 51.2%. To detect significant fibrosis, MEFIB outperformed both MAST and FAST (both p <0.001); AUCs for MEFIB, MAST, and FAST were 0.901 (95% CI 0.875-0.928), 0.770 (95% CI 0.730-0.810), and 0.725 (95% CI 0.683-0.767), respectively. Using rule-in criteria, the positive predictive value of MEFIB (95.3%) was significantly higher than that of FAST (83.5%, p = 0.001) and numerically but not statistically greater than that of MAST (90.0%, p = 0.056). Notably, MEFIB's rule-in criteria covered more of the study population than MAST (34.1% vs. 26.6%; p = 0.006). Using rule-out criteria, the negative predictive value of MEFIB (90.1%) was significantly higher than that of either MAST (69.6%) or FAST (71.8%) (both p <0.001). Furthermore, to diagnose "at risk" non-alcoholic steatohepatitis defined as NAFLD activity score ≥4 and fibrosis stage ≥2, MEFIB outperformed both MAST and FAST (both p <0.05); AUCs for MEFIB, MAST, and FAST were 0.768 (95% CI 0.728-0.808), 0.719 (95% CI 0.671-0.766), and 0.687 (95% CI 0.640-0.733), respectively.

Conclusions: MEFIB was better than MAST and FAST for detection of significant fibrosis as well as "at risk" NASH. All three models provide utility for the risk stratification of NAFLD.

Lay summary: Non-alcoholic fatty liver disease (NAFLD) affects over 25% of the general population worldwide and is one of the main causes of chronic liver disease. Because so many individuals have NAFLD, it is not practical to perform liver biopsies to identify those with more severe disease who may require pharmacological interventions. Therefore, accurate non-invasive tests are crucial. Herein, we compared three such tests and found that a test called MEFIB was the best at detecting patients who might require treatment.
Full Text
https://www.sciencedirect.com/science/article/pii/S0168827822029841
DOI
10.1016/j.jhep.2022.07.020
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192744
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