Optimizing surveillance of low-risk metabolic dysfunction associated steatotic liver disease using transient elastography.
Eur J Gastroenterol Hepatol
; 36(4): 476-481, 2024 Apr 01.
Article
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| MEDLINE
| ID: mdl-38407839
ABSTRACT
BACKGROUND:
Most people with metabolic dysfunction-associated steatotic liver disease (MASLD) lack significant fibrosis and are considered low-risk. Surveillance strategy for low-risk MASLD remains uncertain.AIM:
Identify which low-risk subjects can avoid follow-up vibration-controlled transient elastography (VCTE) within 1 year.METHODS:
Retrospective analysis of two independent low-risk MASLD cohorts (baseline liver stiffness [LS]â <â 8kPa) with routine 6-12 months follow-up VCTE. The primary outcome was LSâ ≥â 8kPa on follow-up, requiring referral and further work-up according to current guidance. Predictors of the primary outcome on univariate and multivariate logistic regression were incorporated into a decision algorithm, and validated in an independent cohort.RESULTS:
Of 206 subjects in the derivation cohort, 96 were low-risk. After a median of 10 months, 24 (25%) low-risk subjects had LSâ ≥â 8kPa. Baseline LS ( P â <â 0.01) and ALT change from baseline ( P â =â 0.02) (multivariate AUROCâ =â 0.84 [0.74-0.94]) predicted the primary outcome, and were incorporated to a two-step decision algorithm. Low-risk subjects with baseline LSâ <â 5.5 kPa can avoid repeating VCTE in a year, while those with LSâ >â 6.8 kPa require one. For intermediate baseline LS (5.5-6.8kPa), repeat VCTE is only indicated when ALT increase > 6 U/L. The algorithm had 92% negative predictive value, 78% specificity, and 78% accuracy in the derivation cohort. In the validation cohort (nâ =â 64), it had 91% NPV, 72% specificity, and 71% accuracy.CONCLUSION:
In low-risk MASLD, a simple algorithm combining baseline LS and ALT change can be used to safely avoid a repeat VCTE in a year.
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Bases de datos:
MEDLINE
Asunto principal:
Diagnóstico por Imagen de Elasticidad
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Límite:
Humans
Idioma:
En
Revista:
Eur J Gastroenterol Hepatol
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2024
Tipo del documento:
Article