ArticleLiver international : official journal of the International Association for the Study of the Liver2025
Precision in Liver Diagnosis: Varied Accuracy Across Subgroups and the Need for Variable Thresholds in Diagnosis of MASLD.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Screening and diagnosis of liver disease in diabetes: a guide and evidence-based assessment.Diabetologia · 2026Review
- The liver in diabetes: current state and future perspectives.Diabetologia · 2026Review
- Diagnostic innovation and models of care to improve fibrosis detection and risk stratification in steatotic liver disease.The Lancet regional health. Europe · 2026Review
- Improving MASLD Risk Stratification in Young Adults with Cardiometabolic Risk Factors and Insulin Resistance Assessment.Journal of the Endocrine Society · 2026Article
- Considerations and clinical utility of referral pathways for early detection of liver disease in at-risk populations.World journal of gastroenterology · 2025Review
- Liver, ageing and disease.Nature reviews. Gastroenterology & hepatology · 2025Review
- Real-World Assessment of Liver Corrected T1 and Magnetic Resonance Elastography in Predicting Liver Disease Progression.Liver international : official journal of the International Association for the Study of the Liver · 2025Article
- Digital Pathology Tailored for Assessment of Liver Biopsies.Biomedicines · 2025Article
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33 authors.
Funding
Abstract
BACKGROUND AND
aimsThe performance of non-invasive liver tests (NITs) is known to vary across settings and subgroups. We systematically evaluated whether the performance of three NITs in detecting advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) varies with age, sex, body mass index (BMI), type 2 diabetes mellitus (T2DM) status or liver enzymes.
methodsData from 586 adult LITMUS Metacohort participants with histologically characterised MASLD were included. The diagnostic performance of the Fibrosis-4 Index (FIB-4), enhanced liver fibrosis (ELF) and vibration-controlled transient elastography liver stiffness measurement (VCTE LSM) was evaluated. Performance was expressed as the area under the receiver operating characteristics curve (AUC). Thresholds for detecting advanced fibrosis (≥F3) were calculated for each NIT for fixed (high) sensitivity, specificity and predictive values.
resultsDifferences in AUC between all subgroups were small and statistically not significant, indicating comparable performance in detecting ≥F3, irrespective of these clinical factors. However, different thresholds were needed to achieve the same level of accuracy with each test. For example, for a fixed sensitivity and specificity, the thresholds for all three NITs were higher in patients with T2DM. Effects for sex, age and liver enzymes were less pronounced.
conclusionsPerformance of the selected NITs in detecting advanced liver fibrosis does not vary substantially with clinical characteristics. However, different thresholds have to be selected to achieve the same sensitivity, specificity and predictive values in the respective subgroups. Large prospective studies are called for to study NIT accuracy considering multiple patient characteristics.
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