ArticleBMC gastroenterology2026
Blood-based non-invasive tests show comparable accuracy in MetALD and MASLD for MRE-defined advanced fibrosis.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNon-invasive tests (NITs) triage individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) for advanced fibrosis (AF). However, evidence for performance in metabolic dysfunction and alcohol-associated liver disease (MetALD) remains limited.
aimTo determine how commonly used NITs perform in MetALD and MASLD using magnetic resonance elastography (MRE) as the reference.
methodsAdults (≥ 18 years) with MASLD /MetALD with cardiometabolic risk factors (CMRFs) and MRI proton density fat fraction-defined steatosis were included. Fibrosis-4 (FIB-4), AST platelet ratio index (APRIF), and NAFLD fibrosis score (NFS) were estimated. Contemporaneous MRE served as the comparator with a cut-off for AF of 3.53 kPa and sensitivity analysis at 3.6 kPa.
resultsAmong 1010 individuals [44 (35-54 years), 35.2% females], 842(83.3%) had MASLD and 168(16.6%) had MetALD. CMRF [diabetes,36.6% vs.30.9%, p = 0.15], hypertension (38.2% vs. 34.5% p = 0.36), dyslipidaemia (31.5% vs. 33.9%, p = 0.55), and burden of AF (15.4% vs. 18.4%, p = 0.33) were similar. APRI was suboptimal [AUC 0.63 (0.60–0.66)]. In MASLD, the AUC for FIB-4 and NFS were 0.77 (0.72–0.82) and 0.80 (0.76–0.85), respectively. For MetALD, the AUC of FIB-4 and NFS were 0.78 (0.68–0.87) and 0.81 (0.70–0.89), respectively. FIB-4 (AUC 0.770 vs. 0.782, p = 0.99) and NFS (AUC 0.804 vs. 0.80, p = 0.94) had similar performance. Sensitivity analysis at 3.6 kPa threshold yielded similar results.
conclusionIn a liver clinic cohort, MASLD and MetALD showed similar CMRF and AF burden. FIB-4 and NFS, but not APRI, show clinically useful and similar performance for AF, supporting inexpensive standard NIT-based triage in MetALD.
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