Introduction: A combination of CAP > 280 dB/m, LSM > 8.5 kPa, and AST > 17 U/L for females or AST > 20 U/L for males is used in clinical practice as a reasonable screening tool for detecting advance liver damage due to dysfunction associated steatohepatitis (MASH). Noninvasive tests that allow to reduce the number procedures to be performed would improve patients’ management and reduce insurance costs. The MASEF score1, a serum-based lipidomic test for detecting at-risk MASH, was used to classify the patients and its performance compared versus the clinical screening criterium. We aim to evaluate the MASEF score as screening tool for detecting patients at higher risk of MASH.
Methods: Consecutive patients with suspected MASH that were seen in a tertiary hepatology clinic were included. On the same day, FibroScan was done, and a blood sample was obtained to calculate the MASEF score. MASEF cutoff was set at 0.33 as previously published1.
Results: Our cohort included 105 patients, 63.8% females with an average age of 52.3 years, CAP 312.6 dB/m, VCTE 8.8 kPa, AST 33.1 U/L, ALT 48.0 U/L and MASEF 0.26. 85 patients were classified as not at-risk by the screening criterium while the MASEF score identified 18 (21.2%) as at-risk MASH (MASEF ≥ 0.33). Significant differences (p< 0.1) in AST, ALT and VCTE were observed between those with MASEF ≥ 0.33 and those with MASEF < 0.33: ALT (57 U/L vs. 29 U/L, p=0.002), AST (41 U/L vs. 23 U/L, p< 0.001) and VCTE (7.2 kPa vs. 6.5 kPa, p=0.078). Among the 20 patients 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. Not significant differences were found between AST, ALT for those with MASEF ≥ 0.33 and those with MASEF < 0.33 in this group. Interestingly, 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=0.009).
Discussion: 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.
1Noureddin M, Truong E, Mayo R, et al. Hepatology. 2024;79(1):135-148.
