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Histological severity and hepatic outcomes in patients with MASLD and discrepant FIB-4 and liver stiffness measurement.

Abstract
Background/aims: Current guidelines recommend a 2-step approach for identifying advanced fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), using FIB-4 followed by liver stiffness measurement (LSM) via vibration-controlled transient elastography. However, some patients may exhibit discordant results. This study evaluates the histological severity and outcomes in patients with discordant FIB-4 and LSM results. Methods: This secondary analysis of the VCTE-Prognosis study included 12,950 patients evaluated for MASLD at 16 tertiary centers, of whom 2,915 underwent liver biopsy. Patients were categorized into four groups based on established FIB-4 (1.3) and LSM (8 kPa) cutoffs. Results: F3-F4 fibrosis was observed in 6.4%, 13.7%, 30.6%, and 62.4% in low-FIB-4-low-LSM (n=6,403), high-FIB-4-low-LSM (n=3,017), low-FIB-4-high-LSM (n=1,363), and high-FIB-4-high-LSM (n=2,167) groups, respectively. During a median follow-up of 47.4 months, 248 patients experienced hepatic decompensation, hepatocellular carcinoma, liver transplantation, or liver-related death. The incidence rates of liver-related events (LREs) were 0.67, 1.19, 2.58, and 21.30 per 1,000 person-years, respectively. Compared to low-FIB-4-low-LSM patients, those with low-FIB-4-high-LSM (adjusted subdistribution hazard ratio [aSHR] 4.2) and high-FIB-4-high-LSM (aSHR 21.3) had a significantly higher risk of LREs, while high-FIB-4-low-LSM patients did not. Similar findings were observed when hepatic decompensation and hepatocellular carcinoma were analyzed separately. Conclusions: Approximately 30% of patients in tertiary centers exhibit discordant FIB-4 and LSM results, with LSM more likely reflecting true severity. While some patients with discordant results may have advanced fibrosis, the overall incidence of LREs remains low.
Author
Rabbat, Joseph
Yang, Boyu
Lee, Hye Won
Lin, Huapeng
Tsochatzis, Emmanuel
Petta, Salvatore
Bugianesi, Elisabetta
Yoneda, Masato
Zheng, Ming-Hua
Hagström, Hannes
Boursier, Jérôme
Calleja, José Luis
Goh, George Boon-Bee
Chan, Wah-Kheong
Gallego-Durán, Rocio
Sanyal, Arun J
de Lédinghen, Victor
Newsome, Philip N
Fan, Jian-Gao
Castéra, Laurent
Lai, Michelle
Fournier-Poizat, Céline
Wong, Grace Lai-Hung
Zoncape, Mirko
Pennisi, Grazia
Armandi, Angelo
Nakajima, Atsushi
Liu, Wen-Yue
Shang, Ying
de Saint-Loup, Marc
Llop, Elba
Teh, Kevin Kim Jun
Lara-Romero, Carmen
Asgharpour, Amon
Mahgoub, Sara
Chan, Mandy Sau-Wai
Canivet, Clemence M
Romero-Gomez, Manuel
Wong, Vincent Wai-Sun
Kim, Seung Up
Yip, Terry Cheuk-Fung
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Date
2025-11-11
Type
Journal Article
Subject
Liver Diseases, Liver Cirrhosis, Diagnostic Imaging
Collections
UHB Hepatology
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Citation
Rabbat J, Yang B, Lee HW, Lin H, Tsochatzis E, Petta S, Bugianesi E, Yoneda M, Zheng MH, Hagström H, Boursier J, Calleja JL, Goh GB, Chan WK, Gallego-Durán R, Sanyal AJ, Lédinghen V, Newsome PN, Fan JG, Castéra L, Lai M, Fournier-Poizat C, Wong GL, Zoncape M, Pennisi G, Armandi A, Nakajima A, Liu WY, Shang Y, Saint-Loup M, Llop E, Teh KKJ, Lara-Romero C, Asgharpour A, Mahgoub S, Chan MS, Canivet CM, Romero-Gomez M, Wong VW, Kim SU, Yip TC. Histological severity and hepatic outcomes in patients with metabolic dysfunction-associated steatotic liver disease and discrepant FIB-4 and liver stiffness measurement. Clin Mol Hepatol. 2026 Jan;32(1):289-304. doi: 10.3350/cmh.2025.0888. Epub 2025 Nov 11.
Journal / Source Title
Clinical and Molecular Hepatology
DOI
10.3350/cmh.2025.0888
URI
https://mider.dspace7.openrepository.com/handle/20.500.14200/9255
PMID
41215583
Publisher
Korean Association for the Study of the Liver
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/41215583/
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