| Invited Lecture(JSGE) |
| Fri. November 1st 9:00 - 9:30 Room 4: Portopia Hotel South Wing Portopia Hall |
| Prognostication of metabolic dysfunction-associated steatotic liver disease by non-invasive tests | |||
| Vincent Wong | |||
| Department of Medicine and Therapeutics, The Chinese University of Hong Kong | |||
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| Although metabolic dysfunction-associated steatotic liver disease (MASLD) is emerging as an important cause of cirrhosis and hepatocellular carcinoma (HCC), it is important to acknowledge that only a small proportion of patients will eventually develop these complications in their lifetime before succumbing to cardiovascular disease, extrahepatic cancers, and other causes. Additionally, unlike other chronic liver diseases such as chronic viral hepatitis, the majority of patients are seen by primary care physicians instead of hepatologists. Therefore, it is especially important to use non-invasive tests to predict these complications. Among the various histological features of MASLD, the degree of hepatic fibrosis has the strongest association with the risk of hepatic complications. Not surprisingly, non-invasive tests of fibrosis are also prognostic, while biomarkers of inflammation and steatosis do not appear to enhance the prediction further. The prognostic performance of non-invasive tests of fibrosis correlates well with their diagnostic performance of advanced fibrosis and cirrhosis when liver histology is used as the reference standard. In fact, an individual patient data meta-analysis and the longitudinal VCTE-Prognosis study clearly indicated that liver stiffness measurement by vibration-controlled transient elastography (VCTE) is not inferior to histological fibrosis stage in predicting liver-related events, and VCTE-based Agile scores may even outperform histology in terms of prognostication. Overall, non-invasive tests of fibrosis are better at predicting cirrhotic complications than HCC, likely due to the fact that HCC can develop in a non-cirrhotic liver in patients with MASLD. Thus, HCC prediction models likely require the inclusion of factors beyond hepatic fibrosis, similar to what researchers have done for the prediction of HCC in patients with chronic viral hepatitis. To translate into actionable management strategies, Baveno VII recommended the use of liver stiffness measurement and platelet count to identify clinically significant portal hypertension and high-risk varices, thereby sparing the majority of patients from the need for invasive procedures such as endoscopy and hepatic venous pressure gradient measurement. Nonetheless, several questions remain unanswered. First, the Baveno VII criteria do not apply well to obese patients due to false-positive liver stiffness measurements. Second, although spleen stiffness measurement has emerged as a promising tool to detect portal hypertension, data in MASLD are limited, and further studies are needed to determine the optimal cutoffs, especially with the introduction of the 100 Hz dedicated probe for the spleen. |
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