MASEF Score May Top FIB-4, Clinical Screening for Early MASH Detection

Naim Alkhouri, MD

Credit: Arizona Liver Health

Metabolomics-Advanced StEatohepatitis Fibrosis (MASEF) score seems to be a sensitive and effective tool in detecting patients at-risk for metabolic dysfunction associated steatohepatitis (MASH).^1,2

Arizona Liver Health presented 2 abstracts at the American College of Gastroenterology (ACG) 2024 Meeting held October 25-30 in Philadelphia, Pennsylvania, with data supporting the use of MASEF, with Naim Alkhouri, MD, Chief Medical Office, Chief of Transplant Hepatology, and Director of the Fatty Liver Program at Arizona Liver Health presenting both abstracts.

The first abstract included a cohort of 76 patients, 72.1% of which were female, with an average age of 50 years, aspartate transaminase (AST) of 34.5 U/L, alanine transaminase (ALT) of 50.6 U/L, fibrosis-4 index (FIB-4) of 1.02 and MASEF score of 0.247. Fourteen participants were at risk of MASH according to FIB-4 score (FIB-4 ≥ 1.30) and 10 were at risk according to MASEF score for a concordance rate of 71.4%. The 4 participants with discrepancies had significant differences in vibration-controlled transient elastography (VCTE; 10.6 kPa vs. 5.3 kPa, P =.023). The investigators also found that MASEF identified 9 participants (14.5%) at risk of MASH out of the 62 identified by FIB-4 as not at risk. These 9 participants had higher median values for ALT (123 U/L vs. 30 U/L, P <.001) and AST (54 U/L vs. 23 U/L, P <.001), along with higher median FAST scores (0.2 vs. 0.5, P <.001), and Alkhouri and colleagues noted that FIB-4 may be underestimating their potential risk of MASH.¹

“The MASEF score demonstrates a significant discrepancy in sensitivity compared to the FIB-4, identifyingadditional patients as at-risk who were overlooked by FIB-4. These findings suggest that MASEF score may be a more sensitive tool for detecting at-risk MASH, offering a potential advantage in clinical assessments and patient management,” Alkhouri and colleagues concluded.¹

The second abstract included a cohort of 105 patients, 63.8% of which were female, with an average age of 52.3 years, Controlled Attenuation Parameter (CAP) score of 312.6 dB/m, VCTE of 8.8 kPa, AST of 33.1 U/L, ALT of 48.0 U/L and MASEF of 0.26. Standard screening criteria classified 85 participants as not at risk for MASH while the MASEF score identified 18 (21.2%) as at-risk. Furthermore, AST (41 U/L vs. 23 U/L, P <.001), ALT (57 U/L vs. 29 U/L, P =.002) and VCTE (7.2 kPa vs. 6.5 kPa, P = .078) values significantly differed between those with MASEF ≥ 0.33 and those with MASEF < 0.33.²

In the 20 participants categorized as at-risk according to the clinical screening criterium, the MASEF score confirmed 12 of these diagnoses and classified 8 as not at-risk MASH.AST and ALT did not significantly differ between those with MASEF ≥ 0.33 and those with MASEF < 0.33 in this group, however, VCTE was significantly higher in the 8 patients classified as not at-risk MASH by MASEF score (10.6 kPa vs. 16.1 Kpa; P =.009).²

“The MASEF score demonstrates a heightened sensitivity to detect liver disease risk in patients deemed not at-risk by traditional screening criteria. Patients identified as at-risk by MASEF, exhibited significantly worse liver parameters, suggesting they may have undetected liver conditions. This suggests that MASEF may be an effective tool for early disease detection and intervention, particularly in patients who might be overlooked by traditional screening criteria,” Alkhouri and colleagues concluded.²

REFERENCES

1. Alkhouri N, Martínez-Arranz I, Nadeem R, et al. Identification of At-Risk MASH Patients in Clinical Routine Using the MASEF Score as Non-Invasive Approach. Presented at: ACG 2024 Meeting; October 25-30; Philadelphia, Pennsylvania. Abstract P4644

2. Alkhouri N, Mayo R, Nadeem R, et al. Diagnostic Performance of MASEF score to detect at-risk MASH in Clinical Routine Presented at: ACG 2024 Meeting; October 25-30; Philadelphia, Pennsylvania. Abstract P4646