NON-INVASIVE ASSESSMENT OF STEATOHEPATITIS AND LIVER FIBROSIS IN THE POPULATION AT RISK FOR METABOLIC STEATOTIC LIVER DISEASE

Introduction and Objectives

The overall global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is 30%, with a higher prevalence in Latin America (44,4%). Metabolic dysfunction-associated steatohepatitis (MASH) is a spectrum of MASLD that can progress to advanced fibrosis, cirrhosis, hepatic decompensation and hepatocellular carcinoma. Non-invasive tests (NITs) can help identify and monitor the progression of MASH, as well as predict the risk of liver-related outcomes.

To evaluate the association between steatohepatitis, liver fibrosis and progression predictors using non-invasive tests in the population at risk for MASLD.

Materials and Methods

A prospective observational study based on the analysis of cross-sectional data from adults in a tertiary hospital who provided informed consent. Inclusion criteria were age between 18 and 75 years and the presence of type 2 diabetes, obesity or metabolic syndrome. The NITs used were FIB 4 index, ultrassonography Fatty Liver Index (FLI), transient elastography and shear wave elastography. Data were analyzed using R and were submitted to the non-parametric Mann-Whitney or Wilcoxon tests. A significant level of 5% was adopted.

Results

This study included 131 patients. Of these, 81 (61.8%) had steatohepatitis (FLI≥ 4), 35 (26.7%) significant fibrosis (F≥ 2) and 17 (12.9%) advanced fibrosis (F≥ 3). Gamma-glutamil transferase (GGT) was the only serum biomarker with a statistically significant correlation with both steatohepatitis (p = 0.01582) and significant fibrosis (p = 0.0217). Data are described in table1.

Conclusions

GGT was significantly associated with the presence of steatohepatitis and significant fibrosis, suggesting that GGT may serve as an additional marker to alert clinicians to the presence of MASH and fibrosis.

Conflict of interest: None

	Total Population	No Fibrosis	Fibrosis	p value
Total	131	96	35	-
Baseline characteristics of the participants
Age, years (median/IQR)	64 (57 -69.5)	63 (56.7 – 69)	66 (58 – 71)	0.1159
Sex, female (N - %)	108 (82.4)	77 (80.2)	31 (88.5)	0.3932
Alcohol consumption (N - %)				0.0546
Abstaining	79 (60.3)	53 (55.2)	26 (74.2)
< 10 g/day	36 (27.4)	29 (30.2)	7 (20)
> 10 g/day	9 (6.8)	9 (9.3)	0
Anthropometric measurements
BMI (median - kg/m^2)	31.5	31	33.3	0.1705
Waist circumference (median - cm)	103.25	102	110	0.1234
Hip circumference (median - cm)	105.5	104.5	108.5	0.1737
Waist-to-height ratio	65.14	64.8	66.9	0.185
Laboratory and imaging-based parameters (median/IQR)
AST (U/L)	21 (18 – 28)	20 (17 – 27)	26 (20 – 35)	0.002392
ALT (U/L)	22 (16 – 29.5)	21 (15 – 27.2)	28 (20 – 42)	0.002341
Platelets (10^3/mm^3)	239 (196.5 – 281)	245 (199.7 – 280.)	221 (174 – 292.5)	0.3625
GGT (U/L)	33 (24 – 55.2)	32 (24 – 43)	53 (27 – 72)	0.0217
Ferritin (ng/mL)	129.87 (71.5 – 255)	139 (78 – 277.4)	97 (56.1 – 156.2)	0.06386
CRP (mg/dL)	0.43 (0.24 – 0.83)	0.43 (0.24 – 0.73)	0.45 (0.28 – 0.87)	0.6687
Fibroscan (kPa)	5.5 (4.7 – 6.8)	5.1 (4.5 – 5.9)	9.1 (7.8 – 13.2)	< 0.001
2D-SWE (kPa)	5.4 (4.4 – 6.8)	5 (4.1 – 5.7)	7.4 (6.6 – 10.1)	< 0.001
US-FLI (kPa)	5.5 (4 – 7)	5 (3 – 7)	6 (4.2 – 7)	0.1274
FIB-4	1.19 (0.87 – 1.69)	1.17 (0.86 – 1.58)	1.34 (0.94 – 2)	0.03868
FIB-4 Classification (N - %)				0.05654
Low FIB-4	73 (55.7)	57 (59.3)	16 (45.7)
Indeterminate FIB-4	45 (34.3)	33 (34.3)	12 (34.2)
High FIB-4	13 (9.9)	6 (6.2)	7 (20)