Validation of the American Association for the Study of Liver Disease/European Association for the Study of the Liver Multistep Screening Strategies for Metabolic Dysfunction-associated Steatotic Liver disease

Article Article scientifique Article Validation of the American Association for the Study of Liver Disease/European Association for the Study of the Liver Multistep Screening Strategies for Metabolic Dysfunction-associated Steatotic Liver disease eng 2025-07-10 2025 author Canivet Clémence Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland. 435065 author Ongaro Marie Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland. 676058 author Conquet Nicolas Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland. 752112 author Spahr Laurent François Joséph Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland. 33759 Département de médecine (DEMED) author Goossens Nicolas Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland.,Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland. 509893 Département de médecine (DEMED) 100747 10.1016/j.gastha.2025.100747 40933005 2772-5723 PMC12419083 https://www.sciencedirect.com/science/article/pii/S2772572325001347 Background and aims: Multistep algorithms for noninvasive identification of patients with metabolic dysfunction-associated steatotic liver disease (MASLD), such as the recent American Association for the Study of Liver Disease and European Association for the Study of the Liver MASLD guidelines aim to identify patients who require hepatology referral. We evaluated the performance of these algorithms in the National Health and Nutrition Examination Survey cohort. Methods: We analyzed 7768 adult participants from the National Health and Nutrition Examination Survey 2017-2020 with valid liver stiffness measurement (LSM) data. MASLD was defined as hepatic steatosis (controlled attenuation parameter measurement of ≥ 248 dB/m) with ≥1 cardiometabolic risk factor; significant fibrosis and advanced fibrosis were defined as LSM ≥8 kPa and ≥12 kPa respectively (with sensitivity analysis of 0-30kPa and using the FibroScan-aspartate aminotransferase or Agile algorithms). Results: A total of 44.8% (n = 3479) met metabolic risk criteria, 7.5% (n = 586) met raised Fibrosis-4 Index criteria, and 3.0% (n = 235) met referral criteria. The multistep pathway demonstrated high specificity but limited sensitivity for identifying MASLD with significant fibrosis (sensitivity 21%, 95% confidence interval [CI] 17%-25%) or advanced fibrosis (29%, 95% CI 23%-37%). Sensitivity was particularly low in key subgroups: age < 50 years (6%, 95% CI 3%-11%), women (15%, 95% CI 11%-21%) and patients without type 2 diabetes (16%, 95% CI 12%-20%). Sensitivity improved when targeting more advanced disease: 29% for advanced fibrosis (LSM ≥12 kPa), 54% for FibroScan-aspartate aminotransferase ≥0.67, 35% for Agile 3+ ≥0.68, and 66% for Agile 4 ≥ 0.57. Conclusion: A multistep screening strategy based on metabolic risk criteria, Fibrosis-4 Index, and LSM demonstrates high specificity but low sensitivity for detecting MASLD with significant fibrosis in a US-based populational cohort. Liver fibrosis MASLD Screening Steatotic liver disease Transient elastography Dewey 616 Dewey 617 56 Département de médecine 221 57 Département de chirurgie 222 false Gastro Hep advances 4 10 b4368095-917f-4241-a3ca-2eb2e088f9c3 Article (Published version) Public Canivet_Goossens_Adv_Gastro_Hep_202.pdf 2135601 application/pdf CC BY-4.0 2f1f0bef765a2b1157173b3274786b6d09b77f1ef860489e72f2e83f3be46dd4 7e99421d-b53b-4a22-ae36-86f4aeb2ed77 Supplemental data Public 1-s2.0-S2772572325001347-mmc1.docx 236124 application/vnd.openxmlformats-officedocument.wordprocessingml.document 9d8de695b45e0b24bb58428ff509240463f2240bcb1293b88610c5448153fd42 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Validation of the American Association for the Study of Liver Disease/European Association for the Study of the Liver Multistep Screening Strategies for Metabolic Dysfunction-associated Steatotic Liver disease	Gastro Hep advances			2025	11	42

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Canivet, Clémence