MAFLD fibrosis score: Using routine measures to identify advanced fibrosis in metabolic-associated fatty liver disease

IF 6.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Alimentary Pharmacology & Therapeutics Pub Date : 2023-09-19 DOI:10.1111/apt.17722

Johnny T. K. Cheung, Xinrong Zhang, Grace Lai-Hung Wong, Terry Cheuk-Fung Yip, Huapeng Lin, Guanlin Li, Howard Ho-Wai Leung, Jimmy Che-To Lai, Sanjiv Mahadeva, Nik Raihan Nik Mustapha, Xiao-Dong Wang, Wen-Yue Liu, Vincent Wai-Sun Wong, Wah-Kheong Chan, Ming-Hua Zheng

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引用次数: 2

Abstract

Background

Early screening may prevent fibrosis progression in metabolic-associated fatty liver disease (MAFLD).

Aims

We developed and validated MAFLD fibrosis score (MFS) for identifying advanced fibrosis (≥F3) among MAFLD patients.

Methods

This cross-sectional, multicentre study consecutively recruited MAFLD patients receiving tertiary care (Malaysia as training cohort [n = 276] and Hong Kong and Wenzhou as validation cohort [n = 431]). Patients completed liver biopsy, vibration-controlled transient elastography (VCTE), and clinical and laboratory assessment within 1 week. We used machine learning to select ‘highly important’ predictors of advanced fibrosis, followed by backward stepwise regression to construct MFS formula.

Results

MFS was composed of seven variables: age, body mass index, international normalised ratio, aspartate aminotransferase, gamma-glutamyl transpeptidase, platelet count, and history of type 2 diabetes. MFS demonstrated an area under the receiver-operating characteristic curve of 0.848 [95% CI 0.800–898] and 0.823 [0.760–0.886] in training and validation cohorts, significantly higher than aminotransferase-to-platelet ratio index (0.684 [0.603–0.765], 0.663 [0.588–0.738]), Fibrosis-4 index (0.793 [0.735–0.854], 0.737 [0.660–0.814]), and non-alcoholic fatty liver disease fibrosis score (0.785 [0.731–0.844], 0.750 [0.674–0.827]) (DeLong's test p < 0.05). MFS could include 92.3% of patients using dual cut-offs of 14 and 15, with a correct prediction rate of 90.4%, resulting in a larger number of patients with correct diagnosis compared to other scores. A two-step MFS-VCTE screening algorithm demonstrated positive and negative predictive values and overall diagnostic accuracy of 93.4%, 89.5%, and 93.2%, respectively, with only 4.0% of patients classified into grey zone.

Conclusion

MFS outperforms conventional non-invasive scores in predicting advanced fibrosis, contributing to screening in MAFLD patients.

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MAFLD纤维化评分：使用常规测量来识别代谢相关脂肪肝中的晚期纤维化。

背景：早期筛查可以预防代谢相关脂肪肝（MAFLD）的纤维化进展。目的：我们开发并验证了MAFLD纤维化评分（MFS），用于识别MAFLD患者中的晚期纤维化（≥F3）。方法：这项横断面、多中心研究连续招募接受三级护理的MAFLD患者（马来西亚作为训练队列 = 276]和香港和温州作为验证队列[n = 431]）。患者在1天内完成了肝活检、振动控制瞬态弹性成像（VCTE）以及临床和实验室评估周我们使用机器学习来选择晚期纤维化的“高度重要”预测因子，然后进行后向逐步回归来构建MFS公式。结果：MFS由7个变量组成：年龄、体重指数、国际标准化比率、天冬氨酸转氨酶、γ-谷氨酰转肽酶、血小板计数和2型糖尿病病史。MFS显示，在训练和验证队列中，受试者操作特征曲线下的面积分别为0.848[95%CI 0.800-898]和0.823[0.760-0.86]，显著高于转氨酶与血小板比值指数（0.684[0.603-0.765]，0.663[0.588-0.738]）、纤维化-4指数（0.793[0.735-0.854]，0.737[0.660-0.814]），和非酒精性脂肪性肝病纤维化评分（0.785[0.731-0.844]，0.750[0.674-0.827]）（德龙检验p 结论：MFS在预测晚期纤维化方面优于传统的无创评分，有助于MAFLD患者的筛查。

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来源期刊

Alimentary Pharmacology & Therapeutics 医学-胃肠肝病学

CiteScore

15.60

自引率

7.90%

发文量

527

审稿时长

3-6 weeks

期刊介绍： Alimentary Pharmacology & Therapeutics is a global pharmacology journal focused on the impact of drugs on the human gastrointestinal and hepato-biliary systems. It covers a diverse range of topics, often with immediate clinical relevance to its readership.