Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease
Background/Aims Recently, the Korean Association for the Study of the Liver (KASL) introduced a noninvasive test-based approach that uses the fibrosis-4 (FIB-4) index followed by vibration-controlled transient elastography (VCTE) to identify high-risk patients with metabolic-associated steatotic liv...
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| Format: | Article |
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Korean Association for the Study of the Liver
2025-07-01
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| Series: | Clinical and Molecular Hepatology |
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| Online Access: | http://e-cmh.org/upload/pdf/cmh-2024-1183.pdf |
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| author | Hye Won Lee Jae Seung Lee Mi Na Kim Beom Kyung Kim Jun Yong Park Do Young Kim Sang Hoon Ahn Seung Up Kim |
| author_facet | Hye Won Lee Jae Seung Lee Mi Na Kim Beom Kyung Kim Jun Yong Park Do Young Kim Sang Hoon Ahn Seung Up Kim |
| author_sort | Hye Won Lee |
| collection | DOAJ |
| description | Background/Aims Recently, the Korean Association for the Study of the Liver (KASL) introduced a noninvasive test-based approach that uses the fibrosis-4 (FIB-4) index followed by vibration-controlled transient elastography (VCTE) to identify high-risk patients with metabolic-associated steatotic liver disease (MASLD). In this study, the KASL two-step approach was validated by assessing the risk of liver-related event (LRE) development. Methods We retrospectively analyzed 8,131 patients with MASLD who underwent VCTE between 2012 and 2020. The index date was defined as the date of the VCTE measurement. Using the KASL two-step approach (FIB-4 index and subsequent VCTE), patients were stratified into four groups (low-, intermediate-low-, intermediate-high-, and high-risk groups). Outcomes, including LREs such as decompensation (DCC) or hepatocellular carcinoma (HCC) were evaluated. Results During the follow-up (median 46.6 months), 86 (1.1%) patients developed LREs (39 [0.5%] with DCC and 47 [0.6%] with HCC). The KASL two-step approach classified 67.6%, 17.7%, 5.7% and 9.0% of patients in the low-, intermediate-low-, intermediate-high-, and high-risk groups, respectively. The cumulative incidences of LREs increased proportionally according to risk stratification (0.07%, 0.10%, 0.29%, and 1.51% at 3 years and 0.35%, 0.26%, 1.94% and 5.46% at 5 years). The overall accuracy in predicting LREs ranged from 67.7–99.8%. The FIB-4 index and subsequent Agile3+, Agile 4, or FibroScan aspartate aminotransferase scores showed similar predictive abilities compared to the KASL approach. Conclusions The KASL two-step approach is an effective and practical method for risk stratification in patients with MASLD, optimizing patient care through early identification of high-risk individuals. |
| format | Article |
| id | doaj-art-c4ad7bb4571f45d0846ecd31e7f7a14f |
| institution | Matheson Library |
| issn | 2287-2728 2287-285X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Korean Association for the Study of the Liver |
| record_format | Article |
| series | Clinical and Molecular Hepatology |
| spelling | doaj-art-c4ad7bb4571f45d0846ecd31e7f7a14f2025-07-10T00:37:01ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2025-07-013131018103110.3350/cmh.2024.11832230Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver diseaseHye Won Lee0Jae Seung Lee1Mi Na Kim2Beom Kyung Kim3Jun Yong Park4Do Young Kim5Sang Hoon Ahn6Seung Up Kim7 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, KoreaBackground/Aims Recently, the Korean Association for the Study of the Liver (KASL) introduced a noninvasive test-based approach that uses the fibrosis-4 (FIB-4) index followed by vibration-controlled transient elastography (VCTE) to identify high-risk patients with metabolic-associated steatotic liver disease (MASLD). In this study, the KASL two-step approach was validated by assessing the risk of liver-related event (LRE) development. Methods We retrospectively analyzed 8,131 patients with MASLD who underwent VCTE between 2012 and 2020. The index date was defined as the date of the VCTE measurement. Using the KASL two-step approach (FIB-4 index and subsequent VCTE), patients were stratified into four groups (low-, intermediate-low-, intermediate-high-, and high-risk groups). Outcomes, including LREs such as decompensation (DCC) or hepatocellular carcinoma (HCC) were evaluated. Results During the follow-up (median 46.6 months), 86 (1.1%) patients developed LREs (39 [0.5%] with DCC and 47 [0.6%] with HCC). The KASL two-step approach classified 67.6%, 17.7%, 5.7% and 9.0% of patients in the low-, intermediate-low-, intermediate-high-, and high-risk groups, respectively. The cumulative incidences of LREs increased proportionally according to risk stratification (0.07%, 0.10%, 0.29%, and 1.51% at 3 years and 0.35%, 0.26%, 1.94% and 5.46% at 5 years). The overall accuracy in predicting LREs ranged from 67.7–99.8%. The FIB-4 index and subsequent Agile3+, Agile 4, or FibroScan aspartate aminotransferase scores showed similar predictive abilities compared to the KASL approach. Conclusions The KASL two-step approach is an effective and practical method for risk stratification in patients with MASLD, optimizing patient care through early identification of high-risk individuals.http://e-cmh.org/upload/pdf/cmh-2024-1183.pdfmetabolic-associated steatotic liver diseasenoninvasive testtransient elastographyliver-related event |
| spellingShingle | Hye Won Lee Jae Seung Lee Mi Na Kim Beom Kyung Kim Jun Yong Park Do Young Kim Sang Hoon Ahn Seung Up Kim Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease Clinical and Molecular Hepatology metabolic-associated steatotic liver disease noninvasive test transient elastography liver-related event |
| title | Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease |
| title_full | Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease |
| title_fullStr | Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease |
| title_full_unstemmed | Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease |
| title_short | Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease |
| title_sort | risk stratification by noninvasive tests in patients with metabolic dysfunction associated steatotic liver disease |
| topic | metabolic-associated steatotic liver disease noninvasive test transient elastography liver-related event |
| url | http://e-cmh.org/upload/pdf/cmh-2024-1183.pdf |
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