Diagnostics, Vol. 15, Pages 1591: Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L

Diagnostics doi: 10.3390/diagnostics15131591

Authors:
Miwa Kawanaka
Hideki Fujii
Michihiro Iwaki
Hideki Hayashi
Hidenori Toyoda
Satoshi Oeda
Hideyuki Hyogo
Asahiro Morishita
Kensuke Munekage
Kazuhito Kawata
Tsubasa Tsutsumi
Koji Sawada
Tatsuji Maeshiro
Hiroshi Tobita
Yuichi Yoshida
Masafumi Naito
Asuka Araki
Shingo Arakaki
Takumi Kawaguchi
Hidenao Noritake
Masafumi Ono
Tsutomu Masaki
Satoshi Yasuda
Eiichi Tomita
Masato Yoneda
Akihiro Tokushige
Yoshihiro Kamada
Hirokazu Takahashi
Shinichiro Ueda
Shinichi Aishima
Ken Nishino
Katsunori Ishii
Takashi Fushimi
Hirofumi Kawamoto
Yoshio Sumida
Takeshi Okanoue
Atsushi Nakajima
Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD) Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

Background/Objectives: The possibility of progressive liver fibrosis remains even when alanine aminotransferase (ALT) levels are <30 IU/L. Therefore, we aimed to investigate factors that can predict fibrosis progression in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) with ALT levels ≤ 30 U/L. Methods: This multicenter retrospective cohort study was conducted using data collected between December 1994 and December 2021. Among the 1381 patients with MASLD (CLIONE study) who underwent liver biopsy, we performed decision-tree analysis on factors for stage ≥ 3 in 115 with ALT levels ≤ 30 U/L. Of the 818 patients with MASLD (Kawasaki cohort) who underwent liver biopsy, we included 174 with ALT levels ≤ 30 U/L for validation. Results: In the decision-tree analysis of patients with stage ≥ 3 with ALT levels ≤ 30 U/L, 57% of patients with a fibrosis-4 (FIB-4) index ≥ 2.67 and 70% with both FIB-4 index ≥ 2.67 and type-2 diabetes mellitus (DM) were detected. However, no cases of stage ≥ 3 were observed among patients without type-2 DM with ALT ≤ 30 U/L and a FIB-4 index < 2.67. After verifying the decision-tree analysis, the model construction and validation datasets showed a close correlation. Conclusions: Among patients with MASLD with ALT levels ≤ 30 U/L, those with an FIB-4 index ≥ 2.67, particularly with comorbid type-2 DM, should consider consultation with a hepatologist.

Source link

Miwa Kawanaka www.mdpi.com