acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study

Gong Feng; Ferenc E. Mózes; Dong Ji; Sombat Treeprasertsuk; Takeshi Okanoue; Toshihide Shima; Huiqing Liang; Emmanuel Tsochatzis; Jinjun Chen; Jorn M. Schattenberg; Christian Labenz; Sanjiv Mahadeva; Wah Kheong Chan; Xiaoling Chi; Adele Delamarre; Victor de Lédinghen; Salvatore Petta; Elisabetta Bugianesi; Hannes Hagström; Jerome Boursier; Jose Luis Calleja; George Boon-Bee Goh; Rocio Gallego-Durán; Arun J. Sanyal; Jian-Gao Fan; Laurent Castéra; Michelle Lai; Stephen A. Harrison; Manuel Romero-Gomez; Seung Up Kim; Yongfen Zhu; Geraldine Ooi; Junping Shi; Masato Yoneda; Atsushi Nakajima; Jing Zhang; Monica Lupsor-Platon; Bihui Zhong; Jeremy F.L. Cobbold; Chun-Yan Ye; Peter J. Eddowes; Philip Newsome; Jie Li; Jacob George; Fangping He; Myeong Jun Song; Hong Tang; Yuchen Fan; Jidong Jia; Liang Xu; Su Lin; Yiling Li; Zhonghua Lu; Yuemin Nan; Junqi Niu; Xuebing Yan; Yongjian Zhou; Chenghai Liu; Hong Deng; Qing Ye; Qing-Lei Zeng; Lei Li; Jing Wang; Song Yang; Huapeng Lin; Hye Won Lee; Terry Cheuk-Fung Yip; Céline Fournier-Poizat; Grace Lai-Hung Wong; Grazia Pennisi; Angelo Armandi; Wen-Yue Liu; Ying Shang; Marc de Saint-Loup; Elba Llop; Kevin Kim Jun Teh; Carmen Lara- Romero; Amon Asgharpour; Sara Mahgoub; Mandy Sau-Wai Chan; Clemence M. Canivet; Fanpu Ji; Yongning Xin; Jin Chai; Zhiyong Dong; Giovanni Targher; Christopher D. Byrne; Na He; Man Mi; Feng Ye; Vincent Wai-Sun Wong; Michael Pavlides; Ming-Hua Zheng

doi:10.1016/j.cgh.2024.07.045

acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study

Gong Feng, Ferenc E. Mózes, Dong Ji, Sombat Treeprasertsuk, Takeshi Okanoue, Toshihide Shima, Huiqing Liang, Emmanuel Tsochatzis, Jinjun Chen, Jorn M. Schattenberg, Christian Labenz, Sanjiv Mahadeva, Wah Kheong Chan, Xiaoling Chi, Adele Delamarre, Victor de Lédinghen, Salvatore Petta, Elisabetta Bugianesi, Hannes Hagström, Jerome BoursierJose Luis Calleja, George Boon-Bee Goh, Rocio Gallego-Durán, Arun J. Sanyal, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Stephen A. Harrison, Manuel Romero-Gomez, Seung Up Kim, Yongfen Zhu, Geraldine Ooi, Junping Shi, Masato Yoneda, Atsushi Nakajima, Jing Zhang, Monica Lupsor-Platon, Bihui Zhong, Jeremy F.L. Cobbold, Chun-Yan Ye, Peter J. Eddowes, Philip Newsome, Jie Li, Jacob George, Fangping He, Myeong Jun Song, Hong Tang, Yuchen Fan, Jidong Jia, Liang Xu, Su Lin, Yiling Li, Zhonghua Lu, Yuemin Nan, Junqi Niu, Xuebing Yan, Yongjian Zhou, Chenghai Liu, Hong Deng, Qing Ye, Qing-Lei Zeng, Lei Li, Jing Wang, Song Yang, Huapeng Lin, Hye Won Lee, Terry Cheuk-Fung Yip, Céline Fournier-Poizat, Grace Lai-Hung Wong, Grazia Pennisi, Angelo Armandi, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara- Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Clemence M. Canivet, Fanpu Ji, Yongning Xin, Jin Chai, Zhiyong Dong, Giovanni Targher, Christopher D. Byrne, Na He, Man Mi, Feng Ye, Vincent Wai-Sun Wong^*, Michael Pavlides^*, Ming-Hua Zheng^*

^*Corresponding author for this work

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

Abstract

Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).

Methods: We analyzed data from 3,004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and nine international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9,034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs.

Results: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).

Conclusions: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.

Original language	English
Journal	Clinical Gastroenterology and Hepatology
Early online date	2 Oct 2024
DOIs	https://doi.org/10.1016/j.cgh.2024.07.045
Publication status	E-pub ahead of print - 2 Oct 2024

Keywords

Diagnosis
Fibrotic Metabolic-associated Steatohepatitis
Liver-related Events

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10.1016/j.cgh.2024.07.045

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Feng, G., Mózes, F. E., Ji, D., Treeprasertsuk, S., Okanoue, T., Shima, T., Liang, H., Tsochatzis, E., Chen, J., Schattenberg, J. M., Labenz, C., Mahadeva, S., Chan, W. K., Chi, X., Delamarre, A., de Lédinghen, V., Petta, S., Bugianesi, E., Hagström, H., ... Zheng, M.-H. (2024). acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study. Clinical Gastroenterology and Hepatology. Advance online publication. https://doi.org/10.1016/j.cgh.2024.07.045

@article{d315de3177504309bb4e9ef817e0268f,

title = "acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study",

abstract = "Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs). Methods: We analyzed data from 3,004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and nine international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9,034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs. Results: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).Conclusions: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.",

keywords = "Diagnosis, Fibrotic Metabolic-associated Steatohepatitis, Liver-related Events",

author = "Gong Feng and M{\'o}zes, {Ferenc E.} and Dong Ji and Sombat Treeprasertsuk and Takeshi Okanoue and Toshihide Shima and Huiqing Liang and Emmanuel Tsochatzis and Jinjun Chen and Schattenberg, {Jorn M.} and Christian Labenz and Sanjiv Mahadeva and Chan, {Wah Kheong} and Xiaoling Chi and Adele Delamarre and {de L{\'e}dinghen}, Victor and Salvatore Petta and Elisabetta Bugianesi and Hannes Hagstr{\"o}m and Jerome Boursier and Calleja, {Jose Luis} and {Boon-Bee Goh}, George and Rocio Gallego-Dur{\'a}n and Sanyal, {Arun J.} and Jian-Gao Fan and Laurent Cast{\'e}ra and Michelle Lai and Harrison, {Stephen A.} and Manuel Romero-Gomez and Kim, {Seung Up} and Yongfen Zhu and Geraldine Ooi and Junping Shi and Masato Yoneda and Atsushi Nakajima and Jing Zhang and Monica Lupsor-Platon and Bihui Zhong and Cobbold, {Jeremy F.L.} and Chun-Yan Ye and Eddowes, {Peter J.} and Philip Newsome and Jie Li and Jacob George and Fangping He and Song, {Myeong Jun} and Hong Tang and Yuchen Fan and Jidong Jia and Liang Xu and Su Lin and Yiling Li and Zhonghua Lu and Yuemin Nan and Junqi Niu and Xuebing Yan and Yongjian Zhou and Chenghai Liu and Hong Deng and Qing Ye and Qing-Lei Zeng and Lei Li and Jing Wang and Song Yang and Huapeng Lin and Lee, {Hye Won} and {Cheuk-Fung Yip}, Terry and C{\'e}line Fournier-Poizat and {Lai-Hung Wong}, Grace and Grazia Pennisi and Angelo Armandi and Wen-Yue Liu and Ying Shang and {de Saint-Loup}, Marc and Elba Llop and {Jun Teh}, {Kevin Kim} and Romero, {Carmen Lara-} and Amon Asgharpour and Sara Mahgoub and {Sau-Wai Chan}, Mandy and Canivet, {Clemence M.} and Fanpu Ji and Yongning Xin and Jin Chai and Zhiyong Dong and Giovanni Targher and Byrne, {Christopher D.} and Na He and Man Mi and Feng Ye and {Wai-Sun Wong}, Vincent and Michael Pavlides and Ming-Hua Zheng",

year = "2024",

month = oct,

day = "2",

doi = "10.1016/j.cgh.2024.07.045",

language = "English",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "Elsevier",

}

Feng, G, Mózes, FE, Ji, D, Treeprasertsuk, S, Okanoue, T, Shima, T, Liang, H, Tsochatzis, E, Chen, J, Schattenberg, JM, Labenz, C, Mahadeva, S, Chan, WK, Chi, X, Delamarre, A, de Lédinghen, V, Petta, S, Bugianesi, E, Hagström, H, Boursier, J, Calleja, JL, Boon-Bee Goh, G, Gallego-Durán, R, Sanyal, AJ, Fan, J-G, Castéra, L, Lai, M, Harrison, SA, Romero-Gomez, M, Kim, SU, Zhu, Y, Ooi, G, Shi, J, Yoneda, M, Nakajima, A, Zhang, J, Lupsor-Platon, M, Zhong, B, Cobbold, JFL, Ye, C-Y, Eddowes, PJ, Newsome, P, Li, J, George, J, He, F, Song, MJ, Tang, H, Fan, Y, Jia, J, Xu, L, Lin, S, Li, Y, Lu, Z, Nan, Y, Niu, J, Yan, X, Zhou, Y, Liu, C, Deng, H, Ye, Q, Zeng, Q-L, Li, L, Wang, J, Yang, S, Lin, H, Lee, HW, Cheuk-Fung Yip, T, Fournier-Poizat, C, Lai-Hung Wong, G, Pennisi, G, Armandi, A, Liu, W-Y, Shang, Y, de Saint-Loup, M, Llop, E, Jun Teh, KK, Romero, CL, Asgharpour, A, Mahgoub, S, Sau-Wai Chan, M, Canivet, CM, Ji, F, Xin, Y, Chai, J, Dong, Z, Targher, G, Byrne, CD, He, N, Mi, M, Ye, F, Wai-Sun Wong, V, Pavlides, M & Zheng, M-H 2024, 'acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2024.07.045

TY - JOUR

T1 - acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events

T2 - An international multicenter study

AU - Feng, Gong

AU - Mózes, Ferenc E.

AU - Ji, Dong

AU - Treeprasertsuk, Sombat

AU - Okanoue, Takeshi

AU - Shima, Toshihide

AU - Liang, Huiqing

AU - Tsochatzis, Emmanuel

AU - Chen, Jinjun

AU - Schattenberg, Jorn M.

AU - Labenz, Christian

AU - Mahadeva, Sanjiv

AU - Chan, Wah Kheong

AU - Chi, Xiaoling

AU - Delamarre, Adele

AU - de Lédinghen, Victor

AU - Petta, Salvatore

AU - Bugianesi, Elisabetta

AU - Hagström, Hannes

AU - Boursier, Jerome

AU - Calleja, Jose Luis

AU - Boon-Bee Goh, George

AU - Gallego-Durán, Rocio

AU - Sanyal, Arun J.

AU - Fan, Jian-Gao

AU - Castéra, Laurent

AU - Lai, Michelle

AU - Harrison, Stephen A.

AU - Romero-Gomez, Manuel

AU - Kim, Seung Up

AU - Zhu, Yongfen

AU - Ooi, Geraldine

AU - Shi, Junping

AU - Yoneda, Masato

AU - Nakajima, Atsushi

AU - Zhang, Jing

AU - Lupsor-Platon, Monica

AU - Zhong, Bihui

AU - Cobbold, Jeremy F.L.

AU - Ye, Chun-Yan

AU - Eddowes, Peter J.

AU - Newsome, Philip

AU - Li, Jie

AU - George, Jacob

AU - He, Fangping

AU - Song, Myeong Jun

AU - Tang, Hong

AU - Fan, Yuchen

AU - Jia, Jidong

AU - Xu, Liang

AU - Lin, Su

AU - Li, Yiling

AU - Lu, Zhonghua

AU - Nan, Yuemin

AU - Niu, Junqi

AU - Yan, Xuebing

AU - Zhou, Yongjian

AU - Liu, Chenghai

AU - Deng, Hong

AU - Ye, Qing

AU - Zeng, Qing-Lei

AU - Li, Lei

AU - Wang, Jing

AU - Yang, Song

AU - Lin, Huapeng

AU - Lee, Hye Won

AU - Cheuk-Fung Yip, Terry

AU - Fournier-Poizat, Céline

AU - Lai-Hung Wong, Grace

AU - Pennisi, Grazia

AU - Armandi, Angelo

AU - Liu, Wen-Yue

AU - Shang, Ying

AU - de Saint-Loup, Marc

AU - Llop, Elba

AU - Jun Teh, Kevin Kim

AU - Romero, Carmen Lara-

AU - Asgharpour, Amon

AU - Mahgoub, Sara

AU - Sau-Wai Chan, Mandy

AU - Canivet, Clemence M.

AU - Ji, Fanpu

AU - Xin, Yongning

AU - Chai, Jin

AU - Dong, Zhiyong

AU - Targher, Giovanni

AU - Byrne, Christopher D.

AU - He, Na

AU - Mi, Man

AU - Ye, Feng

AU - Wai-Sun Wong, Vincent

AU - Pavlides, Michael

AU - Zheng, Ming-Hua

PY - 2024/10/2

Y1 - 2024/10/2

N2 - Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs). Methods: We analyzed data from 3,004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and nine international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9,034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs. Results: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).Conclusions: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.

AB - Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs). Methods: We analyzed data from 3,004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and nine international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9,034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs. Results: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).Conclusions: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.

KW - Diagnosis

KW - Fibrotic Metabolic-associated Steatohepatitis

KW - Liver-related Events

U2 - 10.1016/j.cgh.2024.07.045

DO - 10.1016/j.cgh.2024.07.045

M3 - Article

SN - 1542-3565

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

ER -

acFibroMASH index for the diagnosis of fibrotic MASH and prediction of liver-related events: An international multicenter study

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