MetALD: Diagnosis and Prognosis With Non-Invasive Tests.

Background: Non-invasive tests (NITs) are central to diagnosing and stratifying risk in steatotic liver disease (SLD). However, it remains unclear whether guideline-recommended NIT cut-offs apply to metabolic and alcohol-related liver disease (MetALD).

Aim: Evaluate the diagnostic and prognostic performance of five NITs in patients with MetALD.

Screening for advanced steatotic liver disease.

Steatotic liver disease often progresses asymptomatically, with the risk of advancing to cirrhosis and liver cancer. Early detection of advanced liver disease through screening presents an opportunity to prevent severe outcomes, if said screening is linked to effective intervention. This Review evaluates the feasibility of screening for advanced steatotic liver disease through the lens of the Wilson and Jungner criteria.

Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the general population and is the fastest growing cause of hepatocellular carcinoma (HCC). Current guidelines recommend HCC surveillance in patients with cirrhosis when annual HCC incidence exceeds 1% without specifying the role of non-invasive tests in patient selection.

Objective: To define non-invasive test thresholds to select patients with MASLD for HCC surveillance.

Detecting at-risk steatotic liver disease and liver fibrosis in the community.

Advanced liver fibrosis and "At-Risk" metabolic dysfunction-associated steatohepatitis (At-Risk MASH) are present in 5% and 10%, respectively, of community-based patients with steatotic liver disease and metabolic risk factors and/or excess alcohol consumption. Identification of these patients is critical to guide prognosis and management due to their increased risk of liver decompensation and HCC. In addition, identification of At-Risk MASH will assist in targeting those eligible for pharmacotherapy.

Global patterns of utilization of noninvasive tests for the clinical management of metabolic dysfunction-associated steatotic liver disease.

Background: Noninvasive tests (NITs) are used to risk-stratify metabolic dysfunction-associated steatotic liver disease. The aim was to survey global patterns of real-world use of NITs.

Methods: A 38-item survey was designed by the Global NASH Council.

Staging liver fibrosis and cirrhosis using non-invasive tests in people with chronic hepatitis B to inform WHO 2024 guidelines: a systematic review and meta-analysis.

Background: Non-invasive tests (aspartate aminotransferase-to-platelet ratio index [APRI] and transient elastography [FibroScan]) were recommended in the 2015 WHO guidelines to guide treatment decisions in people with chronic hepatitis B. We updated the systematic review and meta-analysis that informed the 2015 guidelines to inform new cutoffs for non-invasive tests for the diagnosis of significant fibrosis and cirrhosis for the 2024 WHO guidelines for chronic hepatitis B.

Methods: We searched PubMed (MEDLINE), Embase, and Science Citation Index Expanded (Web of Science) for studies published in any language between Jan 1, 2014, and Feb 15, 2023.

Moving diagnosis of liver fibrosis into the community.

Chronic liver disease (CLD) is a leading cause of death worldwide, with alcohol consumption and metabolic risk factors accounting for the majority of cases of CLD in many developed countries. Currently, specific strategies for the early diagnosis of CLD are lacking and consequently most cases are diagnosed at an advanced stage, which is associated with negative consequences for disease management and prognosis. Screening for CLD is based on either detection of chronic viral hepatitis B and C, or detection of liver fibrosis in patients with steatotic liver disease related to alcohol or metabolic dysfunction.

Gender-Equity Model for Liver Allocation Using Artificial Intelligence (GEMA-AI) for Waiting List Liver Transplant Prioritization.

Background & Aims: We aimed to develop and validate an artificial intelligence score (gender-equity model for liver allocation using artificial intelligence [GEMA-AI]) to predict liver transplantation (LT) waiting list outcomes using the same input variables contained in existing models.

Methods: This was a cohort study including adult LT candidates enlisted in the United Kingdom (2010-2020) for model training and internal validation and in Australia (1998-2020) for external validation. GEMA-AI combined international normalized ratio, bilirubin, sodium, and the Royal Free Hospital glomerular filtration rate in an explainable artificial neural network.

Quantification of alcohol intake in patients with steatotic liver disease and excessive alcohol intake.

Background & Aims: Quantifying alcohol intake is crucial for subclassifying participants with steatotic liver disease (SLD) and interpreting clinical trials of alcohol-related liver disease (ALD) and metabolic and alcohol-related liver disease (MetALD). However, the accuracy of self-reported alcohol intake is considered imprecise. We compared the diagnostic and prognostic utility of self-reported alcohol intake with blood-based biomarkers of alcohol intake: phosphatidylethanol (PEth) and carbohydrate-deficient transferrin (CDT).

Steatotic liver disease.

Steatotic liver disease is the overarching term for conditions characterised by abnormal lipid accumulation in the liver (liver or hepatic steatosis). Steatotic liver disease encompasses what was previously termed non-alcoholic fatty liver disease (NAFLD), which is now called metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, steatotic liver disease includes alcohol-related liver disease (ALD) and MetALD, the new classification for the overlap between MASLD and ALD, and rare causes of liver steatosis.

Cost-Effectiveness of the Baveno VI Criteria Compared With Endoscopy for High-Risk Varices in Patients With Child-Pugh A Cirrhosis.

Background & Aims: Although upper gastrointestinal endoscopy (EGD) remains the gold standard for detecting varices in cirrhosis, the Baveno VI criteria proposed a combination of transient elastography and platelet count that could rule out high-risk varices, therefore sparing the need for an endoscopy, with significant potential cost savings. We performed a cost-effectiveness analysis of the Baveno VI criteria compared with EGD in the diagnosis of high-risk varices in cirrhosis.

Methods: We built an analytical decision model to estimate the cost and benefits of using the Baveno VI criteria compared with EGD in patients with Child-Pugh A cirrhosis.

Use of non-invasive diagnostic tools for metabolic dysfunction-associated steatohepatitis: A qualitative exploration of challenges and barriers.

Background And Aims: Non-invasive tests (NITs) are underutilized for diagnosis and risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD), despite good accuracy. This study aimed to identify challenges and barriers to the use of NITs in clinical practice.

Methods: We conducted a qualitative exploratory study in Germany, Italy, United Kingdom and United States.

Progress is impossible without change: understanding the evolving nomenclature of steatotic liver disease and its effect on hepatology practice.

The American, European, and Latin American liver societies have proposed a change in the nomenclature we use to describe alcohol-related liver disease and non-alcoholic fatty liver disease. Additionally, a term encompassing both is now advocated: steatotic liver disease, which includes metabolic dysfunction associated steatotic liver disease (MASLD) and MASLD with greater alcohol consumption (MetALD). These classifications offer increased relevance for clinicians, researchers, and patients alike.

The role of gut barrier dysfunction in postoperative complications in liver transplantation: pathophysiological and therapeutic considerations.

Purpose: Gut barrier dysfunction is a pivotal pathophysiological alteration in cirrhosis and end-stage liver disease, which is further aggravated during and after the operational procedures for liver transplantation (LT). In this review, we analyze the multifactorial disruption of all major levels of defense of the gut barrier (biological, mechanical, and immunological) and correlate with clinical implications.

Methods: A narrative review of the literature was performed using PubMed, PubMed Central and Google from inception until November 29th, 2023.