DIAGNOSTIC ACCURACY OF NON INVASIVE TESTS FOR FIBROSIS IN METABOLIC DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disorder. Fibrosis stage drives hepatic morbidity and mortality. Non-invasive tests (NITs) can replace liver biopsy (LB) in routine practice, yet their performance under the new MASLD terminology has not been assessed in Argentina. Thus, our aim was to assess the accuracy of six NITs for detecting significant fibrosis (SF ≥ F2) and advanced fibrosis (AF ≥ F3) in MASLD.

Materials and Methods

We carried out a cross-sectional multicenter study of 219 adults with MASLD who underwent liver biopsy (2019-2024). Secondary steatosis was excluded. Fibrosis was graded with the Kleiner system. APRI, FIB-4, NAFLD Fibrosis Score (NFS), SAFE, Forns, and transient elastography liver stiffness (TE; FibroScan®) were evaluated. Diagnostic accuracy was expressed as AUROC, sensitivity (Se), specificity (Sp), positive (PPV) and negative predictive value (NPV). Optimal cut-offs were derived with Youden’s index; the two best AUROCs were compared using DeLong’s test.

Results

Median age 54 years; 52 % women; BMI 31 kg/m²; diabetes 32 %; NASH 57 %. Fibrosis distribution: F0 18 %, F1 27 %, F2 24 %, F3 12 %, F4 19 %. For SF, TE and SAFE had the highest AUROCs (0.95 and 0.75). TE cut-off 7.8 kPa achieved Se 92 %, Sp 95 %, PPV 96 %, NPV 90 %. For AF, TE and SAFE again led (0.96 and 0.79); TE cut-off 8.9 kPa provided Se 96 %, Sp 90 %, PPV 81 %, NPV 98 % (DeLong p < 0.001) (Table).

Conclusions

n this Argentinian MASLD cohort, TE outperformed five serum-based NITs for identifying SF and AF, but required higher thresholds than those reported in Europe and the United States. Regional multicentre studies are needed to validate MASLD-specific cut-offs and optimise NIT use.

Conflict of interest: None