MEFIB bests MAST, FAST for detection of fibrosis in NAFLD patients

Magnetic resonance elastography (MRE) plus FIB-4 (MEFIB) outperforms both magnetic resonance imaging [MRI]-aspartate aminotransferase (MAST) and FibroScan-AST (FAST) in detecting stage ≥2 fibrosis and at-risk nonalcoholic steatohepatitis (NASH), reveals a study.

All three models, however, are useful in stratifying the risk of patients with nonalcoholic fatty liver disease (NAFLD).

A total of 563 patients with biopsy-prove NAFLD were included in this prospective study. Participants had undergone contemporaneous MRE, MRI proton density fat fraction (MRI-PDFF), and FibroScan from two prospective cohorts derived from Southern California and Japan. The researchers evaluated the diagnostic performances of models by area under the receiver-operating characteristic curve (AUC).

NAFLD patients had a mean age of 56.5 years, of whom 51 percent were women and 51.2 percent had significant fibrosis.

For the detection of significant fibrosis, MEFIB surpassed both MAST and FAST (p<0.001 for both, with AUCs of 0.901 (95 percent confidence interval [CI], 0.875‒0.928) for MEFIB, 0.770 (95 percent CI, 0.730‒0.810) for MAST, and 0.725 (95 percent CI, 0.683‒0.767) for FAST.

Using the rule-in criteria, MEFIB demonstrated a significantly higher positive predictive value than FAST (95.3 percent vs 83.5 percent; p=0.001). It also showed greater value than did MAST (90.0 percent; p=0.056), but it did not reach statistical significance. Of note, the rule-in criteria of MEFIB covered more patients than MAST (34.1 percent vs 26.6 percent; p=0.006).

In the rule-out criteria, MEFIB also showed a significantly greater negative predictive value than either MAST or FAST (90.1 percent vs 69.6 percent and 71.8 percent; p<0.001).

For the diagnosis of at-risk NASH, defined as NAFLD activity score ≥4 and fibrosis stage ≥2, MEFIB still bested both MAST and FAST (p<0.05 for both). The AUCs for MEFIB, MAST, and FAST were 0.768 (95 percent CI, 0.728‒0.808), 0.719 (95 percent CI, 0.671‒0.766), and 0.687 (95 percent CI, 0.640‒0.733), respectively.

“NAFLD affects over 25 percent of the general population worldwide and is one of the main causes of chronic liver disease,” the researchers said.

“Because so many individuals have NAFLD, it is not practical to perform liver biopsies to identify those with more severe disease who may require pharmacological interventions. Therefore, accurate noninvasive tests are crucial,” they added.