Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study

Abstract

Background and Aims: Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD. Approach and Results: This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts (p < 0.05). Conclusions: An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.

Liver function indicators and risk of hepatocellular carcinoma: a bidirectional mendelian randomization study

“…ALT , located in the cytosol, and AST, located in the mitochondria, are released from damaged hepatic cells into the blood after hepatocellular injury or death ( Song et al, 2012 ). ALT and AST are potentially useful surrogates for alcohol-induced liver disease and nonalcoholic fatty liver disease (NAFLD), defined as hepatic steatosis in the absence of excessive alcohol consumption ( Kim et al, 2023 ). ALP is present in the ducts of the liver, and GGT is located on liver cell membranes ( Inoue et al, 2023 ).…”

Monitoring disease progression in metabolic dysfunction‐associated steatotic liver disease

“…LSM on MRE prognostication was supported further with IPDMA of 1707 patients from six international MASLD patient cohorts with longitudinal follow‐up data (median of 3 (4.2) years); the HR for developing liver‐related events with MRE of 5–8 kPa was 11.0 (95% CI: 7.03–17.1, p < 0.001) and for ≥8 kPa was 15.9 (95% CI: 9.32–27.2, p < 0.001), compared to those with MRE < 5 kPa 76 . These results led to the development of an MRE‐based prediction model that predicts hepatic decompensation accurately; the multivariable model included age, MRE, albumin, AST and platelets had excellent discrimination for the three and 5‐year risk of hepatic decompensation, with a c‐statistic between 0.871–0.912 and 0.876–0.891, respectively 77 …”

“…76 These results led to the development of an MRE-based prediction model that predicts hepatic decompensation accurately; the multivariable model included age, MRE, albumin, AST and platelets had excellent discrimination for the three and 5-year risk of hepatic decompensation, with a c-statistic between 0.871-0.912 and 0.876-0.891, respectively. 77 MRI-derived iron-corrected T1 (cT1) is another MRI modality validated as an NIT to identify MASH and stage fibrosis. 78,79 The predictive value of MRI-cT1 was assessed in patients with compensated chronic liver disease (41% has MASLD) and followed up for 693 patient-years (median (IQR) 43 (26-58) months); clinical outcomes (ascites, variceal bleeding, hepatic encephalopathy, hepatocellular carcinoma, liver transplantation and mortality) were predicted by liver cT1 > 825 ms with HR 9.9 (95% CI: 1.29-76.4, p = 0.007).…”

Diagnosis and non‐invasive assessment of MASLD in type 2 diabetes and obesity

“…80,119,[134][135][136] A new model based on MRE, albumin, AST and platelets achieved high accuracy in predicting hepatic decompensation in MASLD. 137 However, MRI-based evaluations are more costly and not widely available; hence, their use may be restricted to only some large tertiary care settings.…”

“…Other non‐invasive tests, such as the ELF panel, MRI‐AST (MAST) score and MRE, either alone or in combination with FIB4 (called MEFIB index), have also been shown to be predictive of liver‐related events and mortality 80,119,134–136 . A new model based on MRE, albumin, AST and platelets achieved high accuracy in predicting hepatic decompensation in MASLD 137 . However, MRI‐based evaluations are more costly and not widely available; hence, their use may be restricted to only some large tertiary care settings.…”