Postęp MASH do marskości, dekompensacji i śmiertelności oraz użyteczność testów nieinwazyjnych w wykrywaniu i stratifikacji ryzyka

BACKGROUND: Recognition and management of metabolic dysfunction-associated steatohepatitis (MASH) are hindered by variability in diagnostic practices and limited real-world data on disease progression. This study assessed the use of non-invasive testing (NIT) in MASH identification and estimated incidence rates and time-to-disease progression. METHODS: Adults in the TARGET-NASH cohort (enrolled 2016-2023) were included. MASH was confirmed via medical records, NITs, pathology reports, and imaging. Patients with MASH and significant/advanced fibrosis/cirrhosis (F2/F3/F4) were included. Outcomes included progression to cirrhosis, liver-related complications, and all-cause mortality. RESULTS: Among 1964 patients (median age 59, median BMI 34), 79% had data to calculate Fibrosis-4 score (FIB-4), 36% had FibroScan, and 29% had biopsy. Among the 776 F2-F3 patients, 17% progressed to cirrhosis over a median follow-up (mFU) time of 64.6 months. In F2-F3 patients, one unit increase in FIB-4 was associated with 14% increased hazard of cirrhosis; similarly, incidence rates for cirrhosis in patients with liver stiffness measurements (LSMs) 10-15 kPa were 60.8/1000PY (per 1000 person-years; 3.5× higher than those with LSM <10 kPa). Among the 794 patients with compensated cirrhosis (cF4), 46% experienced progression events, 13% died, and 1.3% had a liver transplant (mFU=66.0 months). Among the 394 patients with decompensated cirrhosis (dF4), 29.4% died, and 9.6% had a liver transplant (mFU=62.0 months). Higher FIB-4 was associated with increased risk of decompensation and mortality in cF4 patients. Similarly, patients with LSM ≥15 kPa had a greater incidence rate of mortality (9.1/1000PY vs. 4.3/1000PY and 3.8/1000PY for LSM 10-15 kPa and <10 kPa, respectively). CONCLUSIONS: The burden of MASH underscores the urgency of standardizing NIT use and diagnosis. Expanding FibroScan use, automating FIB-4 calculation, and increasing awareness of NITs can improve early detection and risk stratification, thereby improving patient outcomes.