Comparison of diagnostic accuracy and utility of non-invasive tests for clinically significant liver disease in a general population with metabolic dysfunction

作者：Laurens A. van Kleef, Jesse Pustjens, Jörn M. Schattenberg, Adriaan G. Holleboom, Manuel Castro Cabezas, Maarten E. Tushuizen, Robert J. de Knegt, M. Arfan Ikram, Harry L.A. Janssen, Sven Francque, Willem Pieter Brouwer · 发表于：Hepatology · 年份：2025 · DOI：10.1097/hep.0000000000001356 · 被引用次数：9 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Diabetes, Cardiovascular Risks, and Lipoproteins

BACKGROUND AND AIMS: Screening for liver disease in the general population requires accurate non-invasive tests (NITs). A head-to-head comparison of NITs for early detection of clinically relevant liver disease among the target population for screening is lacking. APROACH AND RESULTS: Among the meta-cohort (Rotterdam Study and National Health and Nutrition Examination Survey) with metabolic dysfunction aged 18-80 years, 10 NITs were investigated. The diagnostic accuracy for clinically relevant conditions [increased liver stiffness measurement (LSM), at-risk metabolic dysfunction-associated steatohepatitis, advanced fibrosis, or cirrhosis) was assessed. Subgroup analysis included stratification by age group and diabetes/obesity status.We analysed 11,404 participants. Metabolic dysfunction-associated fibrosis 5 (MAF-5) obtained the highest AUC for increased LSM (≥8 kPa: 0.80; ≥12 kPa: 0.87) and advanced fibrosis (AUC: 0.90). Fibrotic NASH index and MAF-5 performed best for detecting metabolic dysfunction-associated steatohepatitis (AUC: 0.93 and AUC: 0.92, p =ns) and SAFE for cirrhosis (AUC: 0.92). To obtain 80% sensitivity for LSM ≥8 kPa, the corresponding MAF-5 cut-off resulted in fewer referrals (42%) compared to fibrosis-4 index (77%) and higher specificity (62% vs. 24%); MAF-5 was also superior for detection of LSM ≥12 kPa and advanced fibrosis. Age-dependent scores yielded lower sensitivity among younger individuals, for example, by referring 20% of the population with th...