Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease
[Background & Aims] Current guidelines recommend a two-step approach for risk stratification in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) involving Fibrosis-4 index (FIB-4) followed by liver stiffness measurement (LSM) by vibration-controlled transient elasto...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Consejo Superior de Investigaciones Científicas (CSIC) |
| Repositorio: | DIGITAL.CSIC. Repositorio Institucional del CSIC |
| OAI Identifier: | oai:digital.csic.es:10261/400656 |
| Acceso en línea: | http://hdl.handle.net/10261/400656 https://api.elsevier.com/content/abstract/scopus_id/105000575199 |
| Access Level: | acceso abierto |
| Palabra clave: | FIB-4 Hepatocellular carcinoma MASLD VCTE Hepatic decompensation |
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oai:digital.csic.es:10261/400656 |
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España |
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Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| title |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| spellingShingle |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease Yip, Terry Cheuk-Fung FIB-4 Hepatocellular carcinoma MASLD VCTE Hepatic decompensation |
| title_short |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| title_full |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| title_fullStr |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| title_full_unstemmed |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| title_sort |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver disease |
| dc.creator.none.fl_str_mv |
Yip, Terry Cheuk-Fung Lee, Hye Won Lin, Huapeng Tsochatzis, Emmanuel Petta, Salvatore Bugianesi, Elisabetta Yoneda, Masato Zheng, Ming-Hua Hagström, Hannes Boursier, Jérôme Calleja, José Luis Goh, George Boon-Bee Chan, Wah-Kheong Gallego-Durán, Rocío Sanyal, Arun J. Ledinghen, Victor de Newsome, Philip N. Fan, Jian-Gao Castéra, Laurent Lai, Michelle Fournier-Poizat, Céline Wong, Grace Lai-Hung Pennisi, Grazia Armandi, Angelo Nakajima, Atsushi Liu, Wen-Yue Shang, Ying de Saint-Loup, Marc Llop, Elba Teh, Kevin Kim Jun Lara-Romero, Carmen Asgharpour, Amon Mahgoub, Sara Chan, Mandy Sau-Wai Canivet, Clémence M. Romero-Gómez, Manuel Kim, Seung Up Wong, Vincent Wai-Sun |
| author |
Yip, Terry Cheuk-Fung |
| author_facet |
Yip, Terry Cheuk-Fung Lee, Hye Won Lin, Huapeng Tsochatzis, Emmanuel Petta, Salvatore Bugianesi, Elisabetta Yoneda, Masato Zheng, Ming-Hua Hagström, Hannes Boursier, Jérôme Calleja, José Luis Goh, George Boon-Bee Chan, Wah-Kheong Gallego-Durán, Rocío Sanyal, Arun J. Ledinghen, Victor de Newsome, Philip N. Fan, Jian-Gao Castéra, Laurent Lai, Michelle Fournier-Poizat, Céline Wong, Grace Lai-Hung Pennisi, Grazia Armandi, Angelo Nakajima, Atsushi Liu, Wen-Yue Shang, Ying de Saint-Loup, Marc Llop, Elba Teh, Kevin Kim Jun Lara-Romero, Carmen Asgharpour, Amon Mahgoub, Sara Chan, Mandy Sau-Wai Canivet, Clémence M. Romero-Gómez, Manuel Kim, Seung Up Wong, Vincent Wai-Sun |
| author_role |
author |
| author2 |
Lee, Hye Won Lin, Huapeng Tsochatzis, Emmanuel Petta, Salvatore Bugianesi, Elisabetta Yoneda, Masato Zheng, Ming-Hua Hagström, Hannes Boursier, Jérôme Calleja, José Luis Goh, George Boon-Bee Chan, Wah-Kheong Gallego-Durán, Rocío Sanyal, Arun J. Ledinghen, Victor de Newsome, Philip N. Fan, Jian-Gao Castéra, Laurent Lai, Michelle Fournier-Poizat, Céline Wong, Grace Lai-Hung Pennisi, Grazia Armandi, Angelo Nakajima, Atsushi Liu, Wen-Yue Shang, Ying de Saint-Loup, Marc Llop, Elba Teh, Kevin Kim Jun Lara-Romero, Carmen Asgharpour, Amon Mahgoub, Sara Chan, Mandy Sau-Wai Canivet, Clémence M. Romero-Gómez, Manuel Kim, Seung Up Wong, Vincent Wai-Sun |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
The Government of the Hong Kong Special Administrative Region Chinese University of Hong Kong Yip, Terry Cheuk-Fung [0000-0002-1819-2464] Tsochatzis, Emmanuel [0000-0001-5069-2461] Petta, Salvatore [0000-0002-0822-9673] Bugianesi, Elisabetta [0000-0002-0502-4381] Yoneda, Masato [0000-0001-7815-549X] Zheng, Ming-Hua [0000-0003-4984-2631] Hagström, Hannes [0000-0002-8474-1759] Calleja, José Luis [0000-0002-5278-0163] Goh, George Boon-Bee [0000-0001-8221-5299] Gallego-Durán, Rocío [0000-0002-9452-1661] Newsome, Philip N. [0000-0001-6085-3652] Pennisi, Grazia [0000-0001-9518-4751] Nakajima, Atsushi [0000-0002-6263-1436] Romero-Gómez, Manuel 0000-0001-8494-8947 Kim, Seung Up 0000-0002-9658-8050 Wong, Vincent Wai-Sun 0000-0003-2215-9410 Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72] |
| dc.subject.none.fl_str_mv |
FIB-4 Hepatocellular carcinoma MASLD VCTE Hepatic decompensation |
| topic |
FIB-4 Hepatocellular carcinoma MASLD VCTE Hepatic decompensation |
| description |
[Background & Aims] Current guidelines recommend a two-step approach for risk stratification in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) involving Fibrosis-4 index (FIB-4) followed by liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) or similar second-line tests. This study aimed to examine the prognostic performance of this approach. |
| publishDate |
2025 |
| dc.date.none.fl_str_mv |
2025 2025 2025 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article http://purl.org/coar/resource_type/c_6501 Publisher's version info:eu-repo/semantics/publishedVersion |
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article |
| status_str |
publishedVersion |
| dc.identifier.none.fl_str_mv |
http://hdl.handle.net/10261/400656 https://api.elsevier.com/content/abstract/scopus_id/105000575199 |
| url |
http://hdl.handle.net/10261/400656 https://api.elsevier.com/content/abstract/scopus_id/105000575199 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
The underlying dataset has been published as supplementary material of the article in the publisher platform at DOI https://doi.org/10.1016/j.jhep.2025.01.014 https://doi.org/10.1016/j.jhep.2025.01.014 Sí |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
| dc.publisher.none.fl_str_mv |
Elsevier BV |
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Elsevier BV |
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reponame:DIGITAL.CSIC. Repositorio Institucional del CSIC instname:Consejo Superior de Investigaciones Científicas (CSIC) |
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Consejo Superior de Investigaciones Científicas (CSIC) |
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DIGITAL.CSIC. Repositorio Institucional del CSIC |
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DIGITAL.CSIC. Repositorio Institucional del CSIC |
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1869425664455606272 |
| spelling |
Prognostic performance of the two-step clinical care pathway in metabolic dysfunction-associated steatotic liver diseaseYip, Terry Cheuk-FungLee, Hye WonLin, HuapengTsochatzis, EmmanuelPetta, SalvatoreBugianesi, ElisabettaYoneda, MasatoZheng, Ming-HuaHagström, HannesBoursier, JérômeCalleja, José LuisGoh, George Boon-BeeChan, Wah-KheongGallego-Durán, RocíoSanyal, Arun J.Ledinghen, Victor deNewsome, Philip N.Fan, Jian-GaoCastéra, LaurentLai, MichelleFournier-Poizat, CélineWong, Grace Lai-HungPennisi, GraziaArmandi, AngeloNakajima, AtsushiLiu, Wen-YueShang, Yingde Saint-Loup, MarcLlop, ElbaTeh, Kevin Kim JunLara-Romero, CarmenAsgharpour, AmonMahgoub, SaraChan, Mandy Sau-WaiCanivet, Clémence M.Romero-Gómez, ManuelKim, Seung UpWong, Vincent Wai-SunFIB-4Hepatocellular carcinomaMASLDVCTEHepatic decompensation[Background & Aims] Current guidelines recommend a two-step approach for risk stratification in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) involving Fibrosis-4 index (FIB-4) followed by liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) or similar second-line tests. This study aimed to examine the prognostic performance of this approach.[Methods] The VCTE-Prognosis study was a longitudinal study of patients with MASLD who had undergone VCTE examinations at 16 centres from the US, Europe and Asia with subsequent follow-up for clinical events. The primary endpoint was incident liver-related events (LREs), defined as hepatic decompensation and/or hepatocellular carcinoma.[Results] Of 12,950 patients (mean age 52 years, 41% female, 12.1% LSM >12 kPa), baseline FIB-4, at cut-offs of 1.3 (or 2.0 for age ≥65) and 2.67, classified 66.3% as low-risk and 9.8% as high-risk, leaving 23.9% in the intermediate-risk zone. After classifying intermediate FIB-4 patients as low-risk if LSM was <8.0 kPa and high-risk if LSM was >12.0 kPa, 81.5%, 4.6%, and 13.9% of the full cohort were classified as low-, intermediate-, and high-risk, respectively. At a median (IQR) follow-up of 47 (23-72) months, 248 (1.9%) patients developed LREs. The 5-year cumulative incidence of LREs was 0.5%, 1.0% and 10.8% in the low-, intermediate- and high-risk groups, respectively. Replacing LSM with Agile 3+, Agile 4, and FAST did not reduce the intermediate-risk zone or improve event prediction. Classifying intermediate FIB-4 patients by LSM <10 kPa (low-risk) and >15 kPa (high-risk) reduced the intermediate-risk zone while maintaining predictive performance.[Conclusions] The non-invasive two-step approach of FIB-4 followed by LSM is effective in classifying patients at different risks of LREs.[Impact and implications] Metabolic dysfunction-associated steatotic liver disease (MASLD) is emerging as one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide, but only a minority of patients will develop these complications. Therefore, it is necessary to use non-invasive tests instead of liver biopsy for risk stratification. Additionally, as most patients with MASLD are seen in primary care instead of specialist settings, cost and availability of the tests should be taken into consideration. In this multicentre study, the use of the Fibrosis-4 index followed by liver stiffness measurement by vibration-controlled transient elastography effectively identified patients who would later develop liver-related events. The results support current recommendations by various regional guidelines on a clinical care pathway based on non-invasive tests to diagnose advanced liver fibrosis.The study was supported in part by the Noncommunicable Chronic Diseases-National Science and Technology Major Project of China (2023ZD0508700), General Research Fund by the Hong Kong SAR Government (14106923), and Direct Grant of The Chinese University of Hong Kong (2024.065).Peer reviewedElsevier BVThe Government of the Hong Kong Special Administrative RegionChinese University of Hong KongYip, Terry Cheuk-Fung [0000-0002-1819-2464]Tsochatzis, Emmanuel [0000-0001-5069-2461]Petta, Salvatore [0000-0002-0822-9673]Bugianesi, Elisabetta [0000-0002-0502-4381]Yoneda, Masato [0000-0001-7815-549X]Zheng, Ming-Hua [0000-0003-4984-2631]Hagström, Hannes [0000-0002-8474-1759]Calleja, José Luis [0000-0002-5278-0163]Goh, George Boon-Bee [0000-0001-8221-5299]Gallego-Durán, Rocío [0000-0002-9452-1661]Newsome, Philip N. [0000-0001-6085-3652]Pennisi, Grazia [0000-0001-9518-4751]Nakajima, Atsushi [0000-0002-6263-1436]Romero-Gómez, Manuel 0000-0001-8494-8947Kim, Seung Up 0000-0002-9658-8050Wong, Vincent Wai-Sun 0000-0003-2215-9410Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]202520252025info:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_6501Publisher's versioninfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://hdl.handle.net/10261/400656https://api.elsevier.com/content/abstract/scopus_id/105000575199reponame:DIGITAL.CSIC. Repositorio Institucional del CSICinstname:Consejo Superior de Investigaciones Científicas (CSIC)InglésThe underlying dataset has been published as supplementary material of the article in the publisher platform at DOI https://doi.org/10.1016/j.jhep.2025.01.014https://doi.org/10.1016/j.jhep.2025.01.014Síinfo:eu-repo/semantics/openAccessoai:digital.csic.es:10261/4006562026-05-22T06:33:51Z |
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15.811543 |