Editor’s Note: The Digestive Disease Week (DDW) in the United States is a premier global academic conference in the field of digestive system diseases. The 2024 DDW was successfully held in Washington, D.C., from May 18-21, attracting approximately 14,000 gastroenterologists and hepatologists. At the conference, a study titled “THE REDUCED ACCURACY OF NON-INVASIVE TESTS FOR SIGNIFICANT FIBROSIS IN CHB PATIENTS WITH MASLD,” a collaboration between Professor Jie Li from Nanjing Drum Tower Hospital and Dr. Yihui Yang from Cedars-Sinai Medical Center in Los Angeles, was presented and awarded the AASLD Foundation Abstract Award. Dr. Yihui Yang represented the team in presenting the study and accepting the award. Hepatology Digest has invited the team to share the exciting details of their research.
Metabolic Associated Steatotic Liver Disease (MASLD) is the new term for non-alcoholic fatty liver disease (NAFLD). According to the 2023 MASLD consensus, MASLD is defined as fatty liver confirmed by imaging, combined with any cardiovascular metabolic risk factors (CMRFs), and no other specific causes of fatty liver (e.g., significant alcohol consumption). However, chronic hepatitis B (CHB) was not deeply discussed in this consensus. The impact of CHB on the disease course and outcomes in MASLD patients, especially in Asia where CHB is highly prevalent, remains to be further explored.
This study included a multicenter liver biopsy cohort – the BMOVE cohort (Clinical Prognostic in Chronic Hepatitis B Comorbid with Metabolic Dysfunction-Associated Fatty Liver Disease: A Multicenter Real-World Study) comprising 1036 patients with MASLD and CHB, 439 patients with MASLD alone, and 708 patients with CHB alone. It compared the accuracy of non-invasive tests (NITs) like FIB-4 in these different patient groups.
First, in the MASLD alone and MASLD with CHB groups, propensity score matching (PSM) was performed for gender, age, BMI, hypertension, diabetes, triglycerides (TG), and high-density lipoprotein (HDL). The presence of CHB was found to significantly reduce the accuracy of FIB-4.
Further comparison of FIB-4 diagnostic performance between CHB and CHB+MASLD patients showed similar efficacy in diagnosing significant fibrosis, advanced fibrosis, and cirrhosis after PSM for gender, age, qHBsAg, HBeAg, and HBV DNA.
In the CHB combined steatosis cohort, patients were further divided into three groups based on the presence of CMRFs: (A) CHB with steatosis but no CMRFs; (B) CHB with MASLD and 1-3 CMRFs; (C) CHB with MASLD and 4-5 CMRFs. The diagnostic performance of three representative NITs, including FIB-4, APRI, and NFS, was compared among these groups. Optimal cutoffs for diagnosing significant liver fibrosis (≥2) were determined based on group A. The study found that in group A, the optimal cutoffs for FIB-4, APRI, and NFS were 1.26, 0.56, and -3.55, respectively, with corresponding area under the curve (AUC) values of 0.73, 0.75, and 0.67. In group B, the AUC values for FIB-4, APRI, and NFS were 0.62, 0.62, and 0.55, respectively. The AUC further decreased in group C.
In summary, compared to MASLD alone patients, FIB-4 performed poorly in diagnosing advanced fibrosis and cirrhosis in MASLD with CHB patients. Additionally, the diagnostic accuracy of FIB-4 for significant liver fibrosis decreased significantly with an increasing number of metabolic factors. This study highlights the high heterogeneity in the newly named MASLD, especially in regions with high CHB prevalence. Further development and optimization of non-invasive scoring tools are needed to improve the assessment of liver fibrosis in these patients.
Acknowledgments: Special thanks to Professor Junping Shi’s team from Hangzhou Normal University Affiliated Hospital, Professor Liang Xu ‘s team from Tianjin Second People’s Hospital, and Professor Youwen Tan’s team from Zhenjiang Third People’s Hospital for their data support and guidance.
Expert Profiles
Yihui Yang Dr. Yihui Yang is currently training in the gastroenterology department at Cedars-Sinai Medical Center in Los Angeles. He graduated from the National Defense Medical College in Taiwan and the University of Oxford, and completed postdoctoral research under Professor Mindie Nguyen at Stanford University. His research focuses on the epidemiology, clinical medicine, and machine learning in liver diseases. In 2019, he was awarded the Emerging Liver Scholar by the American Association for the Study of Liver Diseases (AASLD). He has published 114 articles as the first or corresponding author in journals such as JAMA Oncology, Journal of Hepatology, Gastroenterology, Gut, Hepatology, and American Journal of Gastroenterology, with 5126 citations and an h-index of 31.
Jie Li Professor Jie Li is the Administrative Director and Chief Physician of the Department of Infectious Diseases at Nanjing Drum Tower Hospital, a professor at Nanjing University, and a doctoral supervisor. She has been a visiting scholar at Stanford University and the University of Hong Kong. She is recognized as a Jiangsu Province Innovative Talent, Jiangsu Distinguished Medical Expert, and a leading talent in Jiangsu Health Innovation Team. She is the President-elect of the Infectious Disease Branch of the Jiangsu Medical Association, Vice President of the Infectious Physician Branch of the Jiangsu Medical Doctor Association, a standing committee member of the Liver Disease Professional Committee of the Chinese Research Hospital Association, and a youth member of the Liver Disease Branch of the Chinese Medical Association. She has undertaken four National Natural Science Foundation projects and 22 provincial and ministerial projects. She has published over 70 SCI papers in journals such as Lancet Gastroenterology & Hepatology, Hepatology, American Journal of Gastroenterology, eClinicalMedicine, Clinical Gastroenterology Hepatology, and Protein & Cell, with three papers selected as ESI highly cited papers.
