拉丁美洲和北美代谢功能障碍相关脂肪变性肝病（masld）患者的非侵入性检查（nits）和预后预测因素的表现

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101951

Zobair Younossi , Leyla de Avila , Claudia P. Oliveira , Cristiane Villela-Nogueira , Marlen Ivon Castellanos Fernandez , Adrian Carlos Gadano , Marco Antonio Arrese Jimenez , Naim Alkhouri , Winston Dunn , Giada Sebastiani , Luis Antonio Diaz Piga , Brian Pearlman , Juan Pablo Arab , Rida Nadeem , Felice Cinque , Nicholas Dunn , Licet Gonzalez Fabian , Ahmed Almohsen , Nathalie Leite , Ethan Friend , Mário Guimarães Pessôa

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引用次数: 0

摘要

简介和目标masld在世界范围内非常普遍。我们评估了拉丁美洲（LA）与北美（NA） MASLD患者的NITs表现和预后预测因素。患者和方法Global-MASLD项目纳入了肝活检和NITs （FIB-4，肝刚度测量（LSM）通过瞬时弹性成像）的MASLD患者。评估NITs预测晚期纤维化（AF=F3-F4）和预后的性能。结果共纳入3904例MASLD患者[N=892人，来自5个拉美国家（阿根廷、巴西、智利、古巴、墨西哥），N=3012人来自北美（美国/加拿大）]。来自洛杉矶的MASLD患者年龄较大，BMI较低（肥胖64%对85%），更瘦的MASLD(5.6%对2.7%)，更多的T2D(49%对38%)(p<0.001)，但AF的发生率相似（p=0.56）。房颤的临床人口学预测因子包括年龄和T2D （p < 0.05）。LA- masld的NIT准确性低于NA- masld: FIB-4的AUC （95% CI）为0.75（0.71-0.79）比0.81 (0.79-0.83)，LSM为0.73（0.67-0.80）比0.78 (0.75-0.81)，LA和NA的Agile-3+ 0.76（0.70-0.82）。当LA患者FIB-4≥1.01，NA患者FIB-4≥1.17时，灵敏度达到80%（低风险，筛查截止）；FIB-4≥2.35对FIB-4≥2.40的特异性为95%（高风险、诊断截止）。在调整后的（年龄、性别、T2D）比例风险模型中，两组中组织学或NITs纤维化严重程度与不良结局（死亡、失代偿、HCC）相关（调整后的风险比（aHR） >1.0）（图）。结论LA地区smasld患者T2D发生率高于NA地区，但肥胖发生率低于NA地区。普通的NITs在LA-MASLD中准确率较低。组织学和NIT纤维化分期是两组不良结局的独立预测因素。

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PERFORMANCE OF NON-INVASIVE TESTS (NITS) AND PREDICTORS OF OUTCOMES IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD) FROM LATIN AMERICA AND NORTH AMERICA

Introduction and Objectives

MASLD is highly prevalent worldwide. We evaluated performance of NITs and predictors of outcomes in patients with MASLD from Latin America (LA) as compared to North America (NA).

Patients and Methods

The Global-MASLD project enrolled MASLD patients with liver biopsies and NITs (FIB-4, liver stiffness measurement (LSM) by transient elastography). NITs’ performance to predict advanced fibrosis (AF=F3-F4) and outcomes was assessed.

Results

A total of 3,904 MASLD patients were included [N=892 from 5 LA countries (Argentina, Brazil, Chile, Cuba, Mexico) and N=3012 from NA (USA/Canada). MASLD patients from LA were older, had lower BMI (obesity 64% vs. 85%), more lean MASLD (5.6% vs. 2.7%), more T2D (49% vs. 38%) (p<0.001) but similar rates of AF (p=0.56). Clinico-demographic predictors of AF included older age and T2D (p<0.05). The NIT accuracy was lower in LA-MASLD than NA-MASLD: AUC (95% CI) of FIB-4 0.75 (0.71-0.79) vs. 0.81 (0.79-0.83), LSM 0.73 (0.67-0.80) vs. 0.78 (0.75-0.81), Agile-3+ 0.76 (0.70-0.82) for both LA and NA. Sensitivity of 80% (low-risk, screening cutoff) was achieved with FIB-4 ≥1.01 in LA vs. FIB-4 ≥1.17 in NA; specificity of 95% (high-risk, diagnostic cutoff) with FIB-4 ≥2.35 vs. FIB-4 ≥2.40. In adjusted (age, sex, T2D) proportional hazards models, fibrosis severity by histology or NITs was associated with adverse outcomes (death, decompensation, HCC) in both groups (adjusted hazard ratios (aHR) >1.0) (Figure).

Conclusions

MASLD patients from LA have more T2D but less obesity than NA. Common NITs have lower accuracy in LA-MASLD. Histologic and NIT stage of fibrosis are independent predictors of adverse outcomes in both groups.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.