Global multicenter validation of noninvasive fibrosis assessment pathways in MetALD and ALD

作者：Hyundam Gu, Luis Antonio Diaz, Natalia Baeza, Francisco Idalsoaga, Xiaodong Zhou, Ming‐Hua Zheng, Rakhi Maiwall, Shiv K. Sarin, Anand V. Kulkarni, Ramagundam Ramyasri, Fátima Higuera de La Tijera, Helena Pinto, Sofia Carvalhana, Rita Fernandes, Mohammad Qasim Khan, William Alazawi, Wenhao Li, Laura Temperley, David Marti-Aguado, Jordi Gratacós-Ginès, Elisa Pose, María Poca, Berta Cuyàs, Pedro Montes, Fernando Javier Barreyro, Gustavo Ayares, Terry Cheuk‐Fung Yip, Vincent Wai-Sun Wong, Grace Lai‐Hung Wong, Jimmy Che‐To Lai, Cristiane Villela-Nogueira, Nathalie Leite, Gil F. Salles, Claudia Regina Lopes Cardoso, Daniza Contreras, José Antonio Velarde-Ruiz Velasco, Alceo Galimberti, Fernando Bessone, Francisco J Valentin-Cortez, Alejandra Mijangos-Trejo, N Chavéz-Tapia, Ezequiel Ridruejo, Mirta Peralta, Juan Pablo Roblero, Daniela Simian, Pamela Gil, Mohamed El‐Kassas, Ângelo Mattos, Johana Acuña, Roberta Chaves Araujo, Igor Lima Ferraz, Katherine Marrugo, A Torres, Juan Diego Torres, V. Valdes, Jacqueline Córdova, Manual Mendizabal, Cláudia Alves Couto, Guilherme Grossi Lopes Cançado, Thomas G. Cotter, Ahmad Anouti, Elias D. Rady, Hamza Dahshi, Sheel Patel, Ashwani K. Singal, Katrīna Pekarska, Richard Parker, Mohamad Ali Ibrahim, Prasun K. Jalal, Graciela Castro-Narro, Mazen Noureddin, Naim Alkhouri, Winston Dunn, Patrick S. Kamath, Arun Sanyal, Richard K. Sterling, Veeral Ajmera, Rohit Loomba, Marco Arrese, Ramón Bataller, Juan Pablo Arab · 发表于：Hepatology Communications · 年份：2026 · DOI：10.1097/hc9.0000000000001020 · 研究领域：Liver Disease Diagnosis and Treatment、Alcohol Consumption and Health Effects、Liver Disease and Transplantation

BACKGROUND: Noninvasive tests are well validated in metabolic dysfunction-associated steatotic liver disease, but evidence in metabolic dysfunction and alcohol-associated liver disease (MetALD) and alcohol-associated liver disease (ALD) is limited. We evaluated noninvasive test-based clinical care pathways for fibrosis risk stratification in MetALD and ALD. METHODS: This is a multinational, multicenter, cross-sectional study across 35 centers in 16 countries (2013-2025), including adults with MetALD or ALD. Fibrosis was assessed by liver biopsy and/or vibration-controlled transient elastography (VCTE). In biopsy-proven participants, we analyzed the sequential pathway (Fibrosis-4 [FIB-4] first, followed by VCTE for indeterminate FIB-4) to identify advanced fibrosis (≥F3). Diagnostic accuracy was assessed using the AUC. RESULTS: Among 893 participants (41.3% MetALD and 58.7% ALD), the median age was 52 [43.0-61.0] years, and 79.4% were male. The estimated prevalence of advanced fibrosis was 45% (32.2% in MetALD and 54.0% in ALD). Participants with MetALD had a more dysmetabolic profile but lower fibrosis stages than ALD. Among biopsy-proven participants, FIB-4 AUC was 0.720, and VCTE AUC was 0.833. FIB-4 performed better in MetALD than ALD (AUC 0.773 vs. 0.540), while VCTE accuracy was similar across groups. In the sequential pathways, the false-negative rate for advanced fibrosis (misclassified as low risk) was 6.8% (4.9% MetALD and 11.3% ALD). CONCLUSIONS: In biopsy-proven pa...