Photo Credit: Mohammed Haneefa Nizamudeen

A two-step approach combining the SAFE and MR-MASH scores performed well in indicating patients with at-risk MASH.

“Identifying at-risk [MASH] (defined as NASH and ≥ stage 2 fibrosis) in patients with NAFLD is critical,” researchers wrote in Gut. “The steatosis-associated fibrosis estimator (SAFE) is a novel non-invasive test designed to stage significant fibrosis (F ≥2) and the MR-MASH score is an image biomarker proposed for predicting MASH.”

This retrospective study evaluated a two-step approach combining the SAFE and MR-MASH scores in identifying at-risk MASH in 286 patients with MAFLD undergoing contemporaneous laboratory tests, MRI, and liver biopsy. Researchers calculated the SAFE, FIB-4, and MR-MASH scores.

Based on the suggested cutoffs and their intended targets, algorithms combining the SAFE or FIB-4 and MR-MASH were developed from a training set of 172 patients and tested in a validation set of 114 patients.

Combination of SAFE & MR-MASH Performs Well

According to the study findings, the serial combination of SAFE and MR-MASH performs well in indicating at-risk MASH. Among the 286 patients, SAFE outperformed FIB-4 in staging significant fibrosis, with an area under the curve (AUC) of 0.798 versus 0.744, respectively (P<0.01). The MR-MASH score predicted MASH with an AUC of 0.803. Two-step approaches with serial MRI examinations conducted in patients with intermediate-high SAFE or FIB-4 showed 90.0% and 78.6% positive predictive values to identify MASH.

When the researchers looked at the training set cohort, the percentages of misclassifications concerning the two-step approaches applying the MR-MASH score for patients with indeterminate-high SAFE or FIB-4 to predict at-risk MASH were 8.7% and 11.6%, respectively. The percentages of uncertain areas were 5.8% and 3.5%, respectively. In the validation cohort, the percentages of misclassifications were 7.9% and 14.9%, while the percentages of uncertain areas were 6.1% and 2.6%, respectively.

The accuracy, wrong classification, and uncertain area of the serial combination of the SAFE and MR-MASH scores for predicting at-risk MASH for the entire cohort were 85.7%, 5.9%, and 8.4%, respectively. The accuracy, wrong classification, and uncertain area of the serial combination of the FIB-4 and MR-MASH scores for identifying at-risk MASH were 83.9%, 3.1%, and 12.9%, respectively.

“The serial combination of SAFE and MR-MASH performs well in predicting at-risk [MASH],” investigators wrote.