{
  "abstract": "Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease (CLD). The EASL Lancet commission prioritises earlier diagnosis of fibrosis with NHS community pilots underway. We aimed to evaluate the performance of VCTE (vibration-controlled transient elastography) EASL thresholds for ruling-in/ruling-out fibrosis in a real-world setting.Methods Biopsies leading to a diagnosis of MASLD at a large teaching hospital from January 2020 to September 2024 were reviewed. Patients who had undergone a contemporaneous fibroscan were included. Ultrasounds (US) and blood results were reviewed. Patients were classified according to the EASL thresholds for ≥F3 fibrosis; low <8.0 kPa (rule-out), intermediate 8.0–11.9 kPa, and high risk ≥12.0 kPa (rule-in). Biopsy results were grouped into significant (≥F3)/no significant fibrosis (≤F2). Analysis was undertaken using STATA.Results 75 cases met criteria, with median results: age 55 (42–64), BMI 35 (30–40.6), CAP 330 (300–360). VCTE risk categories: low 17/75 (23%), intermediate 12/75 (16%) and high 46/75 (61%). On biopsy 38/75 (51%) had ≥F3 fibrosis of which 30/38 (79%) had high-risk VCTE. Between the ≥F3 vs ≤F2 groups on biopsy, there were significant differences in VCTE (p<0.001), platelets (p=0.028), INR (p<0.001), albumin (p=0.008), ALT (p=0.007) and presence of CLD features/splenomegaly on US (p=0.031 and 0.003 respectively). Compared to those with low risk VCTE, intermediate and high-risk groups were both associated with a higher risk of ≥F3 on biopsy (OR 7.5, p=0.034 and 14, p=0.001 respectively). 50% of those with intermediate risk VCTE had ≥F3 on biopsy. ROC analysis sensitivity for ≤F2 was 94.7% using a threshold of 8.0 kPa whilst specificity for ≥F3 was 68.0% using a threshold of 12.0 kPa, improving to 91.9% using 18.7kPa.On subgroup analysis of high risk VCTE, the group with ≤F2 on biopsy had significantly higher ALT levels (70 vs 35 IU/L) and lower median VCTE (16 vs 24 kPa) compared to those with ≥F3. This association remained significant on multivariable regression.Conclusions In this real-world retrospective study, EASL thresholds performed better at ruling out significant fibrosis than ruling it in. Our findings suggest that the rule-in threshold for ≥F3 may need to be redefined. However, a high proportion with intermediate VCTE readings had ≥F3 on biopsy, suggesting the need for improved risk stratification within this group beyond VCTE alone. Other factors including blood results could be considered when developing MASLD pathways. Further research with larger cohorts is needed for validation.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Sussex, Brighton, UK"
      ],
      "name": "Benedict Murphy"
    },
    {
      "affiliations": [
        "University Hospitals Sussex, Brighton, UK",
        "Brighton and Sussex Medical School, Brighton, UK"
      ],
      "name": "Yazan Haddadin"
    },
    {
      "affiliations": [
        "University Hospitals Sussex, Brighton, UK",
        "Brighton and Sussex Medical School, Brighton, UK"
      ],
      "name": "Lucia Macken"
    }
  ],
  "title": "P24 Non-invasive fibrosis assessment in metabolic dysfunction-associated steatotic liver disease – redefining the grey zone",
  "uid": "cce13a68-7dc2-59be-adb4-968c4449266d"
}