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

Cheung JTK 1 , Zhang X 1 , Wong GL 1 , Yip TC 1 , Lin H 1 , Li G 1 Show all authors , Leung HH 2 , Lai JC 1 , Mahadeva S 3 , Nik Mustapha NR 4 , Wang XD 5 , Liu WY 6 , Wong VW 1 , Chan WK 3 , Zheng MH 5

Affiliations 

  • 1 Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  • 2 Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
  • 3 Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 4 Department of Pathology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
  • 5 Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
  • 6 Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Aliment Pharmacol Ther, 2023 Dec;58(11-12):1194-1204.
PMID: 37724633 DOI: 10.1111/apt.17722

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 

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