acFibroMASH Index for the Diagnosis of Fibrotic MASH and Prediction of Liver-related Events: An International Multicenter Study

Feng G 1 , Mózes FE 2 , Ji D 3 , Treeprasertsuk S 4 , Okanoue T 5 , Shima T 5 Show all authors , Liang H 6 , Tsochatzis E 7 , Chen J 8 , Schattenberg JM 9 , Labenz C 9 , Mahadeva S 10 , Chan WK 10 , Chi X 11 , Delamarre A 12 , de Lédinghen V 12 , Petta S 13 , Bugianesi E 14 , Hagström H 15 , Boursier J 16 , Calleja JL 17 , Goh GB 18 , Gallego-Durán R 19 , Sanyal AJ 20 , Fan JG 21 , Castéra L 22 , Lai M 23 , Harrison SA 24 , Romero-Gomez M 19 , Kim SU 25 , Zhu Y 26 , Ooi G 27 , Shi J 28 , Yoneda M 29 , Nakajima A 29 , Zhang J 30 , Lupsor-Platon M 31 , Zhong B 32 , Cobbold JFL 33 , Ye CY 34 , Eddowes PJ 35 , Newsome P 36 , Li J 37 , George J 38 , He F 39 , Song MJ 40 , Tang H 41 , Fan Y 42 , Jia J 43 , Xu L 44 , Lin S 45 , Li Y 46 , Lu Z 47 , Nan Y 48 , Niu J 49 , Yan X 50 , Zhou Y 51 , Liu C 52 , Deng H 53 , Ye Q 54 , Zeng QL 55 , Li L 56 , Wang J 57 , Yang S 58 , Lin H 59 , Lee HW 25 , Yip TC 59 , Fournier-Poizat C 60 , Wong GL 59 , Pennisi G 13 , Armandi A 14 , Liu WY 61 , Shang Y 62 , de Saint-Loup M 63 , Llop E 17 , Teh KKJ 18 , Lara-Romero C 19 , Asgharpour A 20 , Mahgoub S 64 , Chan MS 60 , Canivet CM 16 , Ji F 65 , Xin Y 66 , Chai J 67 , Dong Z 68 , Targher G 69 , Byrne CD 70 , He N 71 , Mi M 72 , Ye F 73 , Wong VW 74 , Pavlides M 75 , Zheng MH 76

Affiliations 

  • 1 Xi'an Medical University, Xi'an, China; Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
  • 2 Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
  • 3 Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
  • 4 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
  • 5 Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
  • 6 Hepatology Unit, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, China
  • 7 UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom
  • 8 Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • 9 Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Rhineland-Palatinate, Germany; Department of Medicine II, University Medical Center Homburg, Homburg and University of the Saarland, Saarbrücken, Germany
  • 10 Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
  • 11 Department of Hepatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
  • 12 Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, and INSERM U1312, Bordeaux University, Bordeaux, France
  • 13 Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy
  • 14 Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
  • 15 Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden
  • 16 Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, SFR ICAT 4208, Angers University, Angers, France
  • 17 Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
  • 18 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
  • 19 Digestive Diseases Unit and CIBERehd, Virgen Del Rocío University Hospital, Seville, Spain
  • 20 Stravitz-Sanyal Institute of Liver Disease and Metabolic Health, Department of Internal Medicine, VCU School of Medicine, Richmond, Virginia
  • 21 Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China
  • 22 Université Paris Cité, UMR1149 (CRI), INSERM, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
  • 23 Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 24 Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Pinnacle Clinical Research, San Antonio, Texas
  • 25 Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 26 Department of Hepatology and Infection, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, China
  • 27 Centre for Obesity Research and Education, Department of Surgery, Monash University, Melbourne, Australia
  • 28 Department of Hepatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
  • 29 Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
  • 30 The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
  • 31 Department of Medical Imaging, Iuliu Hatieganu, University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor," Cluj-Napoca, Romania
  • 32 Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
  • 33 Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom
  • 34 Institute for the Study of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
  • 35 National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
  • 36 National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, United Kingdom; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • 37 Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
  • 38 Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
  • 39 Department of Hepatobiliary Pancreatic Surgery, Eighth Hospital Affiliated to SunYat-sen University, Futian, Guangdong Province, China
  • 40 Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 41 Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
  • 42 Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
  • 43 Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  • 44 Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
  • 45 Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • 46 Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
  • 47 Clinical Laboratory Center, The Fifth People's Hospital of Wuxi, Wuxi, Jiangsu, China
  • 48 Department of Traditional and Western Medical Hepatology, Hebei Medical University Third Hospital, Shijiazhuang, China
  • 49 Department of Hepatology, Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China
  • 50 Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
  • 51 Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
  • 52 Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • 53 Department of lnfectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  • 54 Department of Hepatology of The Third Central Hospital of Tianjin, Tianjin, China
  • 55 Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • 56 Department of lnfectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
  • 57 Department of Hepatobiliary Diseases, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
  • 58 Center of Hepatology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 59 Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
  • 60 Echosens, Paris, France
  • 61 Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 62 Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
  • 63 Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France
  • 64 National Institute for Health Research, Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, United Kingdom
  • 65 Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
  • 66 Department of Infectious Diseases, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
  • 67 Department of Gastroenterology, Southwest Hospital, Army Medical University, Chongqing, China
  • 68 Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
  • 69 Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy
  • 70 Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Southampton, United Kingdom
  • 71 Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
  • 72 Xi'an Medical University, Xi'an, China
  • 73 Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
  • 74 Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: wongv@cuhk.edu.hk
  • 75 Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom. Electronic address: michael.pavlides@cardiov.ox.ac.uk
  • 76 MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, Zhejiang, China. Electronic address: zhengmh@wmu.edu.cn
Clin Gastroenterol Hepatol, 2024 Oct 02.
PMID: 39362618 DOI: 10.1016/j.cgh.2024.07.045

Abstract

BACKGROUND & AIMS: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).

METHODS: We analyzed data from 3004 individuals with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD) across 29 Chinese and 9 international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9034 patients with MASLD to examine associations between the acFibroMASH index and the risk of LREs.

RESULTS: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).

CONCLUSIONS: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Similar publications