M et ALD : Diagnosis and Prognosis With Non‐Invasive Tests

作者：Nikolaj Torp, Mads Israelsen, Stine Johansen, Georg Semmler, Camilla Dalby Hansen, K. Bech, Mette Lehmann Andersen, Katrine Holtz Thorhauge, Peter Andersen, Helle Lindholm Schnefeld, Johanne Kragh Hansen, Ellen Lyngbeck Jensen, Emil Deleuran Hansen, Ida Falk Villesen, Katrine Prier Lindvig, Diana Julie Leeming, M.A. Karsdal, Emmanuel Tsochatzis, Maja Thiele, Aleksander Krag · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2025 · DOI：10.1111/apt.70281 · 被引用次数：11 · 研究领域：Liver Disease Diagnosis and Treatment、Alcohol Consumption and Health Effects、Liver Disease and Transplantation

BACKGROUND: Non-invasive tests (NITs) are central to diagnosing and stratifying risk in steatotic liver disease (SLD). However, it remains unclear whether guideline-recommended NIT cut-offs apply to metabolic and alcohol-related liver disease (MetALD). AIM: Evaluate the diagnostic and prognostic performance of five NITs in patients with MetALD. METHODS: Single-centre study with 423 SLD patients, of whom 102 (24%) had MetALD. Patients were classified using histological or controlled attenuation parameter-defined hepatic steatosis and self-reported alcohol intake. We assessed the circulating markers of FIB-4, LiverRisk score, ELF and ADAPT together with transient elastography (TE) using established cut-offs for advanced fibrosis (≥ F3). Liver histology served as reference. Prognostic performance for hepatic decompensation and all-cause mortality was evaluated over a median follow-up of 62 months. RESULTS: Among circulating NITs in MetALD, ELF and ADAPT both had the highest diagnostic accuracy (AUROC = 0.90), while it was lowest with LiverRisk score (AUROC = 0.74). The indeterminate zone between rule-out and rule-in cut-offs was largest for FIB-4 (34%). TE and circulating NIT concordance was highest for LiverRisk score (81%) to rule-out ≥ F3, and highest for ELF (88%) to rule-in ≥ F3. All included NITs predicted decompensation-free survival with their corresponding rule-out or rule-in cut-offs. A sequential 2-tier testing strategy (FIB-4 → TE) effectively stratified risk of deco...