M-PAST score is better than MAST score for the diagnosis of active fibrotic nonalcoholic steatohepatitis

Kento Imajo; Yusuke Saigusa; Takashi Kobayashi; Koki Nagai; Shinya Nishida; Nobuyoshi Kawamura; Hiroyoshi Doi; Michihiro Iwaki; Asako Nogami; Yasushi Honda; Takaomi Kessoku; Yuji Ogawa; Hiroyuki Kirikoshi; Satoshi Yasuda; Hidenori Toyoda; Hideki Hayashi; Shigehiro Kokubu; Daisuke Utsunomiya; Hirokazu Takahashi; Shinichi Aishima; Beom Kyung Kim; Nobuharu Tamaki; Satoru Saito; Masato Yoneda; Rohit Loomba; Atsushi Nakajima

doi:10.1111/hepr.13927

M-PAST score is better than MAST score for the diagnosis of active fibrotic nonalcoholic steatohepatitis

Hepatol Res. 2023 Sep;53(9):844-856. doi: 10.1111/hepr.13927. Epub 2023 Jun 15.

Authors

Kento Imajo^{1

2}, Yusuke Saigusa³, Takashi Kobayashi¹, Koki Nagai^{1

2}, Shinya Nishida², Nobuyoshi Kawamura^{1

2}, Hiroyoshi Doi², Michihiro Iwaki¹, Asako Nogami¹, Yasushi Honda¹, Takaomi Kessoku¹, Yuji Ogawa⁴, Hiroyuki Kirikoshi⁵, Satoshi Yasuda⁶, Hidenori Toyoda⁶, Hideki Hayashi⁷, Shigehiro Kokubu², Daisuke Utsunomiya⁸, Hirokazu Takahashi⁹, Shinichi Aishima¹⁰, Beom Kyung Kim¹¹, Nobuharu Tamaki^{11

12}, Satoru Saito¹, Masato Yoneda¹, Rohit Loomba¹¹, Atsushi Nakajima¹

Affiliations

¹ Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
² Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan.
³ Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan.
⁴ Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
⁵ Department of Clinical Laboratory, Yokohama City University Hospital, Yokohama, Japan.
⁶ Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
⁷ Department of Gastroenterology and Hepatology, Gifu Municipal Hospital, Gifu, Japan.
⁸ Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
⁹ Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.
¹⁰ Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan.
¹¹ NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California, USA.
¹² Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

Abstract

Background: Clinical trials enroll patients with active fibrotic nonalcoholic steatohepatitis (NASH) (nonalcoholic fatty liver disease [NAFLD] activity score ≥ 4) and significant fibrosis (F ≥ 2); however, screening failure rates are high following biopsy. We developed new scores to identify active fibrotic NASH using FibroScan and magnetic resonance imaging (MRI).

Methods: We undertook prospective primary (n = 176), retrospective validation (n = 169), and University of California San Diego (UCSD; n = 234) studies of liver biopsy-proven NAFLD. Liver stiffness measurement (LSM) using FibroScan or magnetic resonance elastography (MRE), controlled attenuation parameter (CAP), or proton density fat fraction (PDFF), and aspartate aminotransferase (AST) were combined to develop a two-step strategy-FibroScan-based LSM followed by CAP with AST (F-CAST) and MRE-based LSM followed by PDFF with AST (M-PAST)-and compared with FibroScan-AST (FAST) and MRI-AST (MAST) for diagnosing active fibrotic NASH. Each model was categorized using rule-in and rule-out criteria.

Results: Areas under receiver operating characteristic curves (AUROCs) of F-CAST (0.826) and M-PAST (0.832) were significantly higher than those of FAST (0.744, p = 0.004) and MAST (0.710, p < 0.001). Following the rule-in criteria, positive predictive values of F-CAST (81.8%) and M-PAST (81.8%) were higher than those of FAST (73.5%) and MAST (70.0%). Following the rule-out criteria, negative predictive values of F-CAST (90.5%) and M-PAST (90.9%) were higher than those of FAST (84.0%) and MAST (73.9%). In the validation and UCSD cohorts, AUROCs did not differ significantly between F-CAST and FAST, but M-PAST had a higher diagnostic performance than MAST.

Conclusions: The two-step strategy, especially M-PAST, showed reliability of rule-in/-out for active fibrotic NASH, with better predictive performance compared with MAST. This study is registered with ClinicalTrials.gov (number, UMIN000012757).

Keywords: F-CAST; FAST; M-PAST; MAST; active fibrotic NASH.

Abstract

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