| Title: | Development and validation of a noninvasive score for at-risk metabolic dysfunction-associated steatohepatitis in individuals with obesity undergoing bariatric surgery. |
| Journal: | Hepatology |
| Published: | 13 Nov 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41231578/ |
| DOI: | https://doi.org/10.1097/hep.0000000000001612 |
Publication 18940
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Abstract
BACKGROUND AND AIMS: At-risk metabolic dysfunction-associated steatohepatitis (MASH) elevates risks of liver-related and all-cause morbidity and mortality. We developed and validated a noninvasive score using routine clinical indicators to identify at-risk MASH in obesity.</p>
APPROACH AND RESULTS: Using data from 1961 individuals across 5 independent bariatric cohorts with liver biopsy, we developed the predictive score in 1 derivation cohort (n=1095), performed internal validation (bootstrapping), and conducted external validation using the remaining 4 biopsy-confirmed cohorts (n=866). The score was also validated in the international overweight/obese cohorts from the UK Biobank (n=15,745) and NHANES database (n=1573). Predictive value for severe liver-related outcomes (SLROs, including cirrhosis, hepatocellular carcinoma, etc) was assessed in a UK Biobank subcohort (n=1955; median 13.7-year follow-up). Head-to-head comparisons with existing indices were performed. The predictive model, designated as FMO (Fibrotic/at-risk MASH in Obesity), incorporated aspartate aminotransferase, alanine aminotransferase, triglyceride, and high-density lipoprotein cholesterol. The FMO model demonstrated robust discrimination in derivation (AUROC=0.874, 95% CI 0.844-0.905) and nationwide external validation cohorts (AUROCs=0.803-0.874), and in global validation in both NHANES and UK Biobank (AUROCs=0.866 and 0.753, respectively). Longitudinal analysis confirmed SLRO's prediction (the Harrell C-index=0.703). In the derivation cohort, the FMO model demonstrated optimal rule-out [cutoff 0.05, sensitivity ≥0.90, negative predictive value (NPV) 0.976] and rule-in [cutoff 0.22, specificity ≥0.90, positive predictive value (PPV) 0.481] performance. External validation showed NPVs of 0.907-1.00 and PPVs of 0.333-0.630. Comparative analyses revealed superior diagnostic performance of the FMO model versus some existing models.</p>
CONCLUSIONS: The FMO is an accurate and cost-effective noninvasive score for at-risk MASH identification in populations with obesity.</p>
16 Authors
- Xin Huang
- Tao Zhu
- Shumin Li
- Teng Liu
- Shibo Lin
- Hui Liang
- Mingwei Zhong
- Xitai Sun
- Liyong Chen
- Hao Bai
- Zehua Zhao
- Shujuan Lin
- Xuehui Chu
- Zhiyong Dong
- Guangyong Zhang
- Shaozhuang Liu
1 Application
| Application ID | Title |
|---|---|
| 95817 | Sleep health and modifiable lifestyle factors in relation to gastrointestinal disease incidence and mortality |
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