Serum fibrosis tests guide prognosis in metabolic dysfunction associated fatty liver disease patients referred from primary care.

Abstract

BACKGROUND AND AIMS\nMetabolic dysfunction-associated fatty liver disease (MAFLD) is predominately managed in primary care, however there is uncertainty regarding how to best identify patients for specialist referral. We examined the accuracy of non-invasive tests (NITs) as screening tools for the prediction of outcomes in MAFLD patients referred from primary care.\n\n\nMETHODS\nPatients with MAFLD referred by primary care for specialist review to Sir Charles Gairdner Hospital (Cohort One; n=626) or tertiary centers within Western Australia (Cohort Two, n=246) were examined. Hepascore, aspartate aminotransferase to platelet ratio, Fibrosis-4 (FIB-4) and NAFLD fibrosis score (NFS) performed at baseline were examined for their accuracy in predicting liver related death (LRD), decompensation and hepatocellular carcinoma (HCC). Outcomes were collected from hospital records and data-linkage.\n\n\nRESULTS\nThe median (range) follow-up was 5.0 (0.1-13.0) and 3.8 (0.1-10.0) years in Cohorts One and Two. In both cohorts, Hepascore and FIB-4 had the highest area under the curve (AUC) for the prediction of LRD (0.90-0.95 and 0.83-0.94 respectively), decompensation (0.86-0.91 and 0.86-0.87 respectively) and HCC (0.75-0.90 and 0.67-0.85 respectively). The sensitivity and negative predictive values were high (>90%) for Hepascore (cut-off 0.60), FIB-4 (cut-off 1.30) and NFS (cut-off -1.455) for all outcomes in cohort one, and for predicting LRD in cohort two. Hepascore had the highest specificity, classified the greatest proportion of patients as low-risk and was favoured by decision curve analysis as providing the greatest net benefit.\n\n\nCONCLUSIONS\nSerum NIT s accurately stratify risk of liver-related outcomes in MAFLD patients and can be used as a screening tool for patients referred for specialist review by primary care.