The grade of obesity affects the noninvasive diagnosis of advanced fibrosis in individuals with MASLD

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity Pub Date : 2024-05-03 DOI:10.1002/oby.24033

Yasmina Chouik, Adrien Aubin, Marianne Maynard-Muet, Bérénice Segrestin, Laurent Milot, Valérie Hervieu, Fabien Zoulim, Emmanuel Disse, Massimo Levrero, Cyrielle Caussy

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Abstract

Objective

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity. We aimed to assess the impact of obesity on the performance of different noninvasive tests, including liver stiffness measurement (LSM) and Agile3+ (A3+), to detect advanced fibrosis (AF) in a population of patients with MASLD encompassing a wide range of BMI values.

Methods

A total of 479 patients with MASLD were consecutively included (Lyon Hepatology Institute). Clinical data and noninvasive tests, including FibroTest, LSM, A3+, Fibrosis-4 (FIB-4), magnetic resonance elastography, and liver biopsies, were collected. AF was determined by a composite endpoint, i.e., histological stage ≥ F3, overt diagnosis of cirrhosis by magnetic resonance elastography, or concordant LSM ≥ 9.6 kPa and FibroTest ≥ F3.

Results

The median BMI was 35.0 kg/m², and the prevalence of AF was 28.6%. Patients with BMI ≥ 35 versus <35 had a lower proportion of AF, i.e., 19.3% versus 38.1% (p < 0.001), but higher indeterminate status for AF (34.2% vs. 15.4%; p < 0.001). In the case of BMI ≥ 35, LSM had lower specificity to rule in AF (77.9%) versus A3+ (90.4%), but A3+ had decreased sensitivity to rule out AF. A sequential LSM/A3+ strategy achieved high specificity to rule in AF and lowered the proportion of indeterminate cases in patients with BMI ≥ 35.

Conclusions

The grade of obesity affects the detection of MASLD-related AF. A sequential use of LSM/A3⁺ could improve AF detection in patients with BMI ≥ 35.

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肥胖程度影响 MASLD 患者晚期纤维化的无创诊断

目标代谢功能障碍相关性脂肪性肝病（MASLD）与肥胖密切相关。我们旨在评估肥胖对不同无创检验（包括肝脏硬度测量（LSM）和 Agile3+ (A3+)）性能的影响，这些无创检验可在 BMI 值范围广泛的 MASLD 患者群体中检测晚期纤维化（AF）。收集了临床数据和非侵入性检查，包括纤维测试、LSM、A3+、纤维化-4（FIB-4）、磁共振弹性成像和肝活检。房颤由综合终点决定，即组织学分期≥ F3、磁共振弹性成像明显诊断为肝硬化或 LSM ≥ 9.6 kPa 和 FibroTest ≥ F3 一致。体重指数≥35的患者与体重指数<35的患者相比，房颤比例较低，分别为19.3%和38.1%（P< 0.001），但房颤不确定状态的比例较高（34.2%和15.4%；P< 0.001）。在体重指数≥35的情况下，LSM排除房颤的特异性（77.9%）低于A3+（90.4%），但A3+排除房颤的敏感性降低。在 BMI ≥ 35 的患者中，LSM/A3+ 顺序策略可实现较高的房颤排除特异性，并降低不确定病例的比例。连续使用 LSM/A3+ 可以提高 BMI≥35 患者的房颤检出率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obesity 医学-内分泌学与代谢

CiteScore

11.70

自引率

1.40%

发文量

261

审稿时长

2-4 weeks

期刊介绍： Obesity is the official journal of The Obesity Society and is the premier source of information for increasing knowledge, fostering translational research from basic to population science, and promoting better treatment for people with obesity. Obesity publishes important peer-reviewed research and cutting-edge reviews, commentaries, and public health and medical developments.