Abstract：
OBJECTIVE: Noninvasive tests (NITs) for liver fibrosis have been recognized for their clinical utility in metabolic dysfunction-associated steatotic liver disease (MASLD). However, their diagnostic efficacy in detecting liver fibrosis is notably reduced in patients with alcohol-related liver disease. Therefore, ascertaining the reliability of NITs in patients with MASLD with increased alcohol intake (MetALD) is essential.
METHODS: In this cross-sectional study, we reviewed data from 7,918 health check-up participants who underwent both magnetic resonance elastography (MRE) and ultrasound for the diagnosis of hepatic steatosis. The participants were categorized into MASLD and MetALD groups, and the performance of fibrosis-4 (FIB-4) and NAFLD fibrosis score (NFS) were assessed. Advanced hepatic fibrosis (F3) was defined as MRE ≥ 3.6 kPa.
RESULTS: The prevalence of MetALD was 5.8% in this health check-up cohort, and 1.5% of these patients exhibited advanced hepatic fibrosis. Both MetALD and MASLD displayed similar metabolic profiles and hepatic fibrosis burdens. The diagnostic performance of FIB-4 and NFS for MRE ≥ 3.6 kPa showed no noticeable differences in the area under the receiver operating characteristic values between the two groups (0.85 vs. 0.80 in FIB-4). Moreover, the sensitivity (71.4%), specificity (77.3%), and both positive (4.6%) and negative (99.4%) predictive values of NITs for MetALD closely mirrored those observed for MASLD.
CONCLUSIONS: The newly defined MetALD exhibited a high FIB-4 performance, demonstrating reasonable sensitivity and negative predictive value for the initial screening of advanced hepatic fibrosis in MetALD.
UNASSIGNED: In this cross-sectional study, data from 7,918 participants who underwent MRE were analyzed to assess the performance of fibrosis-4 (FIB-4) and nonalcoholic fatty liver disease fibrosis scores in metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake (MetALD). We found that the newly identified MetALD group had high diagnostic accuracy with FIB-4, similar to the MASLD population. These results highlight the potential of FIB-4 as a reliable screening tool for MetALD, even when specific subgroups are considered. Therefore, FIB-4 is a valuable screening tool for identifying advanced fibrosis in the MetALD population.
METHODS: In this cross-sectional study, we reviewed data from 7,918 health check-up participants who underwent both magnetic resonance elastography (MRE) and ultrasound for the diagnosis of hepatic steatosis. The participants were categorized into MASLD and MetALD groups, and the performance of fibrosis-4 (FIB-4) and NAFLD fibrosis score (NFS) were assessed. Advanced hepatic fibrosis (F3) was defined as MRE ≥ 3.6 kPa.
RESULTS: The prevalence of MetALD was 5.8% in this health check-up cohort, and 1.5% of these patients exhibited advanced hepatic fibrosis. Both MetALD and MASLD displayed similar metabolic profiles and hepatic fibrosis burdens. The diagnostic performance of FIB-4 and NFS for MRE ≥ 3.6 kPa showed no noticeable differences in the area under the receiver operating characteristic values between the two groups (0.85 vs. 0.80 in FIB-4). Moreover, the sensitivity (71.4%), specificity (77.3%), and both positive (4.6%) and negative (99.4%) predictive values of NITs for MetALD closely mirrored those observed for MASLD.
CONCLUSIONS: The newly defined MetALD exhibited a high FIB-4 performance, demonstrating reasonable sensitivity and negative predictive value for the initial screening of advanced hepatic fibrosis in MetALD.
UNASSIGNED: In this cross-sectional study, data from 7,918 participants who underwent MRE were analyzed to assess the performance of fibrosis-4 (FIB-4) and nonalcoholic fatty liver disease fibrosis scores in metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake (MetALD). We found that the newly identified MetALD group had high diagnostic accuracy with FIB-4, similar to the MASLD population. These results highlight the potential of FIB-4 as a reliable screening tool for MetALD, even when specific subgroups are considered. Therefore, FIB-4 is a valuable screening tool for identifying advanced fibrosis in the MetALD population.
摘要：
目的：肝纤维化的非侵入性试验（NIT）在代谢功能障碍相关的脂肪变性肝病（MASLD）中的临床应用已得到认可。然而,在酒精相关性肝病患者中,它们在检测肝纤维化方面的诊断效能显著降低.因此,在酒精摄入量增加（MetALD）的MASLD患者中，确定NIT的可靠性至关重要。
方法：在这项横断面研究中，我们回顾了7,918名健康体检参与者的数据,这些参与者同时接受了磁共振弹性成像(MRE)和超声检查以诊断肝脏脂肪变性.参与者被分为MASLD和MetALD组，并评估纤维化-4（FIB-4）和NAFLD纤维化评分（NFS）的表现。晚期肝纤维化（F3）定义为MRE≥3.6kPa。
结果：在该健康检查队列中，MetALD的患病率为5.8％，这些患者中有1.5％表现出晚期肝纤维化。MetALD和MASLD都显示出相似的代谢谱和肝纤维化负担。对于MRE≥3.6kPa，FIB-4和NFS的诊断性能显示两组之间的接收器工作特征值下的区域没有明显差异（0.85vs.FIB-4中的0.80）。此外，灵敏度（71.4%），特异性（77.3%），MetALD的NIT的阳性（4.6％）和阴性（99.4％）预测值与MASLD的观察值非常相似。
结论：新定义的MetALD表现出很高的FIB-4性能，对MetALD晚期肝纤维化的初步筛查具有合理的敏感性和阴性预测值。
■在这项横断面研究中，我们对7,918名接受MRE的参与者的数据进行了分析,以评估代谢功能障碍相关的脂肪变性肝病(MASLD)和酒精摄入量增加的MASLD(MetALD)中纤维化-4(FIB-4)和非酒精性脂肪性肝病纤维化评分的表现.我们发现新发现的MetALD组对FIB-4具有很高的诊断准确性，与MASLD人群相似。这些结果凸显了FIB-4作为MetALD可靠筛选工具的潜力，即使考虑到特定的子组。因此,FIB-4是用于识别MetALD群体中的晚期纤维化的有价值的筛选工具。
方法：在这项横断面研究中，我们回顾了7,918名健康体检参与者的数据,这些参与者同时接受了磁共振弹性成像(MRE)和超声检查以诊断肝脏脂肪变性.参与者被分为MASLD和MetALD组，并评估纤维化-4（FIB-4）和NAFLD纤维化评分（NFS）的表现。晚期肝纤维化（F3）定义为MRE≥3.6kPa。
结果：在该健康检查队列中，MetALD的患病率为5.8％，这些患者中有1.5％表现出晚期肝纤维化。MetALD和MASLD都显示出相似的代谢谱和肝纤维化负担。对于MRE≥3.6kPa，FIB-4和NFS的诊断性能显示两组之间的接收器工作特征值下的区域没有明显差异（0.85vs.FIB-4中的0.80）。此外，灵敏度（71.4%），特异性（77.3%），MetALD的NIT的阳性（4.6％）和阴性（99.4％）预测值与MASLD的观察值非常相似。
结论：新定义的MetALD表现出很高的FIB-4性能，对MetALD晚期肝纤维化的初步筛查具有合理的敏感性和阴性预测值。
■在这项横断面研究中，我们对7,918名接受MRE的参与者的数据进行了分析,以评估代谢功能障碍相关的脂肪变性肝病(MASLD)和酒精摄入量增加的MASLD(MetALD)中纤维化-4(FIB-4)和非酒精性脂肪性肝病纤维化评分的表现.我们发现新发现的MetALD组对FIB-4具有很高的诊断准确性，与MASLD人群相似。这些结果凸显了FIB-4作为MetALD可靠筛选工具的潜力，即使考虑到特定的子组。因此,FIB-4是用于识别MetALD群体中的晚期纤维化的有价值的筛选工具。
