Rabbat, Joseph;
Yang, Boyu;
Lee, Hye Won;
Lin, Huapeng;
Tsochatzis, Emmanuel;
Petta, Salvatore;
Bugianesi, Elisabetta;
... Yip, Terry Cheuk-Fung; + view all
(2025)
Histological severity and hepatic outcomes in patients with MASLD and discrepant FIB-4 and liver stiffness measurement.
Clinical and Molecular Hepatology
10.3350/cmh.2025.0888.
(In press).
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Abstract
BACKGROUND/AIMS: Current guidelines recommend a 2-step approach for identifying advanced fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), using FIB-4 followed by liver stiffness measurement (LSM) via vibration-controlled transient elastography. However, some patients may exhibit discordant results. This study evaluates the histological severity and outcomes in patients with discordant FIB-4 and LSM results. METHODS: This secondary analysis of the VCTE-Prognosis study included 12,950 patients evaluated for MASLD at 16 tertiary centers, of whom 2,915 underwent liver biopsy. Patients were categorized into four groups based on established FIB-4 (1.3) and LSM (8 kPa) cutoffs. RESULTS: F3-F4 fibrosis was observed in 6.4%, 13.7%, 30.6%, and 62.4% in low-FIB-4-low-LSM (n=6,403), high-FIB-4-low-LSM (n=3,017), low-FIB-4-high-LSM (n=1,363), and high-FIB-4-high-LSM (n=2,167) groups, respectively. During a median follow-up of 47.4 months, 248 patients experienced hepatic decompensation, hepatocellular carcinoma, liver transplantation, or liver-related death. The incidence rates of liver-related events (LREs) were 0.67, 1.19, 2.58, and 21.30 per 1,000 person-years, respectively. Compared to low-FIB-4-low-LSM patients, those with low-FIB-4-high-LSM (adjusted subdistribution hazard ratio [aSHR] 4.2) and high-FIB-4-high-LSM (aSHR 21.3) had a significantly higher risk of LREs, while high-FIB-4-low-LSM patients did not. Similar findings were observed when hepatic decompensation and hepatocellular carcinoma were analyzed separately. CONCLUSIONS: Approximately 30% of patients in tertiary centers exhibit discordant FIB-4 and LSM results, with LSM more likely reflecting true severity. While some patients with discordant results may have advanced fibrosis, the overall incidence of LREs remains low.
| Type: | Article |
|---|---|
| Title: | Histological severity and hepatic outcomes in patients with MASLD and discrepant FIB-4 and liver stiffness measurement |
| Location: | Korea (South) |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3350/cmh.2025.0888 |
| Publisher version: | https://doi.org/10.3350/cmh.2025.0888 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Fibrosis-4 index, fatty liver, liver fibrosis, steatotic liver disease, vibration-controlled transient elastography |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10217232 |
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