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MRE plus FIB-4 (MEFIB) versus FAST in detection of candidates for pharmacological treatment of NASH-


Background and aim: Nonalcoholic fatty liver disease (NAFLD) patients with significant hepatic fibrosis (stage ≥ 2) are at increased risk of liver-related morbidity and are candidates for pharmacologic therapies. In this study, we compared the diagnostic accuracy of MEFIB (the combination of magnetic resonance elastography [MRE] and FIB-4) and FAST (FibroScan-AST; combined liver stiffness measurement by vibration-controlled transient elastography, controlled attenuation parameter, and aspartate aminotransferase) for detecting significant fibrosis. Approach and results: This prospective cohort study included 234 consecutive NAFLD patients who underwent liver biopsy, MRE, and FibroScan at University of California San Diego [UCSD] Cohort, and an independent cohort (N=314) from Yokohama City University, Japan Cohort. The primary outcome was diagnostic accuracy for significant fibrosis (stage ≥ 2). The proportion of significant fibrosis in UCSD and Yokohama cohorts were 29.5% and 66.2%, respectively. Area under the receiver operating characteristic curve (95% confidence interval) of MEFIB (0.860 [0.81-0.91]) was significantly higher than FAST (0.757 [0.69-0.82]) in UCSD cohort (p = 0.005), with consistent results in the Yokohama cohort (AUROC: 0.899 [MEFIB] vs 0.724 [FAST], p < 0.001). When used as the rule-in criteria (MEFIB: MRE ≥ 3.3 kPa and FIB-4 ≥ 1.6, and FAST ≥ 0.67), the positive predictive value for significant fibrosis was 91.2-96.0% for MEFIB, and 74.2-89.2% for FAST. When used as the rule-out criteria (MEFIB: MRE < 3.3 kPa and FIB-4 < 1.6, and FAST ≤ 0.35), negative predictive value for significant fibrosis was 85.6-92.8% for MEFIB, and 57.8-88.3% for FAST. Conclusions: MEFIB has higher diagnostic accuracy than FAST for significant fibrosis in NAFLD, and our results support the utility of a two-step strategy for detecting significant fibrosis in NAFLD.

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