Serum identification of at-risk MASH: The metabolomics-advanced steatohepatitis fibrosis score (MASEF)

Mazen Noureddin, Emily Truong, Rebeca Mayo, Ibon Martínez-Arranz, Itziar Mincholé, Jesus M. Banales, Marco Arrese, Kenneth Cusi, María Teresa Arias-Loste, Radan Bruha, Manuel Romero-Gómez, Paula Iruzubieta, Rocio Aller, Javier Ampuero, José Luis Calleja, Luis Ibañez-Samaniego, Patricia Aspichueta, Antonio Martín-Duce, Tatyana Kushner, Pablo OrtizStephen A. Harrison, Quentin M. Anstee, Javier Crespo, José M. Mato, Arun J. Sanyal

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Early identification of those with NAFLD activity score ≥ 4 and significant fibrosis (≥F2) or at-risk metabolic dysfunction-associated steatohepatitis (MASH) is a priority as these patients are at increased risk for disease progression and may benefit from therapies. We developed and validated a highly specific metabolomics-driven score to identify at-risk MASH. Methods: We included derivation (n = 790) and validation (n = 565) cohorts from international tertiary centers. Patients underwent laboratory assessment and liver biopsy for metabolic dysfunction-associated steatotic liver disease. Based on 12 lipids, body mass index, aspartate aminotransferase, and alanine aminotransferase, the MASEF score was developed to identify at-risk MASH and compared to the FibroScan-AST (FAST) score. We further compared the performance of a FIB-4 + MASEF algorithm to that of FIB-4 + liver stiffness measurements (LSM) by vibration-controlled transient elastography (VCTE). Results: The diagnostic performance of the MASEF score showed an area under the receiver-operating characteristic curve, sensitivity, specificity, and positive and negative predictive values of 0.76 (95% CI 0.72-0.79), 0.69, 0.74, 0.53, and 0.85 in the derivation cohort, and 0.79 (95% CI 0.75-0.83), 0.78, 0.65, 0.48, and 0.88 in the validation cohort, while FibroScan-AST performance in the validation cohort was 0.74 (95% CI 0.68-0.79; p = 0.064), 0.58, 0.79, 0.67, and 0.73, respectively. FIB-4+MASEF showed similar overall performance compared with FIB-4 + LSM by VCTE (p = 0.69) to identify at-risk MASH. Conclusion: MASEF is a promising diagnostic tool for the assessment of at-risk MASH. It could be used alternatively to LSM by VCTE in the algorithm that is currently recommended by several guidance publications.

Original languageEnglish
Pages (from-to)135-148
Number of pages14
Issue number1
StatePublished - Jan 2024


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