Javier Ampuero, Rocío Aller, Rocío Gallego-Durán, Javier Crespo, Jose Luis Calleja, Carmelo García-Monzón, Judith Gómez-Camarero, Joan Caballería, Oreste Lo Iacono, Luis Ibañez, Javier García-Samaniego, Agustín Albillos, Rubén Francés, Conrado Fernández-Rodríguez, Douglas Maya-Miles, Moisés Diago, Maria Poca, Raúl J. Andrade, Raquel Latorre, Francisco Jorquera, Rosa María Morillas, Desamparados Escudero, Manuel Hernández-Guerra, María Jesús Pareja-Megia, Jesús M. Banales, Patricia Aspichueta, Salvador Benlloch, José Miguel Rosales, Juan Turnes, Manuel Romero-Gómez
{"title":"The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis","authors":"Javier Ampuero, Rocío Aller, Rocío Gallego-Durán, Javier Crespo, Jose Luis Calleja, Carmelo García-Monzón, Judith Gómez-Camarero, Joan Caballería, Oreste Lo Iacono, Luis Ibañez, Javier García-Samaniego, Agustín Albillos, Rubén Francés, Conrado Fernández-Rodríguez, Douglas Maya-Miles, Moisés Diago, Maria Poca, Raúl J. Andrade, Raquel Latorre, Francisco Jorquera, Rosa María Morillas, Desamparados Escudero, Manuel Hernández-Guerra, María Jesús Pareja-Megia, Jesús M. Banales, Patricia Aspichueta, Salvador Benlloch, José Miguel Rosales, Juan Turnes, Manuel Romero-Gómez","doi":"10.1007/s00535-024-02098-8","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H), > 5; (b) mixed pattern(M),2–5; (c) cholestatic pattern(C), < 2. Outcomes: (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H <i>vs.</i> 41.9% M <i>vs.</i> 31.9% C) were more common in H-pattern (<i>p</i> = 0.0001),whilst C-pattern was linked to cirrhosis (5.8% H <i>vs.</i> 5.6% M <i>vs.</i> 10.9% C; <i>p</i> = 0.0001). FIB-4(0.74(95% CI 0.69–0.79) <i>vs.</i> 0.83 (95% CI 0.80–0.85); <i>p</i> = 0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69–0.85) <i>vs.</i> 0.84 (95% CI 0.80–0.87); <i>p</i> = 0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12–5.02); <i>p</i> = 0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":6.9000,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00535-024-02098-8","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern.
Objective
To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis.
Methods
Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H), > 5; (b) mixed pattern(M),2–5; (c) cholestatic pattern(C), < 2. Outcomes: (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death.
Results
Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H vs. 41.9% M vs. 31.9% C) were more common in H-pattern (p = 0.0001),whilst C-pattern was linked to cirrhosis (5.8% H vs. 5.6% M vs. 10.9% C; p = 0.0001). FIB-4(0.74(95% CI 0.69–0.79) vs. 0.83 (95% CI 0.80–0.85); p = 0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69–0.85) vs. 0.84 (95% CI 0.80–0.87); p = 0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12–5.02); p = 0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation.
Conclusions
The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.
背景MASLD可表现为肝细胞损伤，可导致转氨酶轻度升高。目的评估生化模式对 MASLD 自然病程的影响，包括组织学中的肝损伤、非侵袭性检验（NITs）的准确性和预后。方法多中心研究纳入了2156例经活检证实的MASLD患者，根据活检时的[ALT/ULN]/[（ALP/ULN）]水平对患者进行分类：（a）肝细胞型（H），5例；（b）混合型（M），2-5例；（c）胆汁淤积型（C），2例。结果：(a) 组织学评估 NAS、MASH 和纤维化的单一成分；(b) NITs 和瞬态弹性成像评估晚期纤维化；(c) 根据失代偿性肝硬化的出现和死亡确定预后。严重脂肪变性、气囊、小叶炎症和 MASH（56.4% H vs. 41.9% M vs. 31.9% C）在 H 型中更为常见（p = 0.0001），而 C 型与肝硬化有关（5.8% H vs. 5.6% M vs. 10.9% C; p = 0.0001）。FIB-4（0.74(95% CI 0.69-0.79) vs. 0.83 (95% CI 0.80-0.85); p = 0.005）和Hepamet纤维化评分（0.77 (95% CI 0.69-0.85) vs. 0.84 (95% CI 0.80-0.87); p = 0.044）在H型中显示出较低的AUROC。C模式[HR 2.37 (95% CI 1.12-5.02); p = 0.024]以及年龄、糖尿病和肝硬化与死亡率有独立关联。结论 与 C 型相比，H 型在组织学上表现出更多的坏死炎症，而 C 型则表现出更多的肝硬化。在H型中，NITs检测纤维化的准确性降低。失代偿事件和死亡的发生率以C型为主。因此，根据生化表现确定MASLD表型可能与临床实践有关。
期刊介绍：
The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.
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