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Background <p>The impact of each factor and the number of positive criteria on pathogenesis and the diagnostic performance of non-invasive tests (NITs) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. This study aimed to investigate the association between the cardiometabolic criteria and the clinical features.</p> Methods <p>This retrospective study investigated clinicopathological characteristics and the diagnostic performance of the Enhanced Liver Fibrosis (ELF) test, fibrosis-4 (FIB-4) index, and nonalcoholic fatty liver disease fibrosis score (NFS) according to the factors and the number of positive cardiometabolic criteria in 1,038 patients with biopsy-proven MASLD.</p> Results <p>Hypertension is a significant risk factor for progression to advanced fibrosis and at-risk metabolic dysfunction-associated steatohepatitis (MASH) in male patients. In contrast, no significant risk factor was identified in female patients. The incidence of advanced fibrosis increased significantly in patients with three or more positive criteria. Similarly, the incidence of at-risk MASH increased significantly in a stepwise manner with the number of positive cardiometabolic criteria. The diagnostic performance of the ELF test for advanced fibrosis exceeded that of the FIB-4 index and NFS for all factors except hypertension. Regardless of the number of positive cardiometabolic criteria, the ELF test demonstrated a superior diagnostic performance for advanced fibrosis.</p> Conclusions <p>MASLD with hypertension in male patients or a higher number of positive cardiometabolic criteria constitutes a significant risk for advanced fibrosis or at-risk MASH. The ELF test is a valuable tool for diagnosing advanced fibrosis progression regardless of individual factors or the number of positive cardiometabolic criteria.</p>

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Impact of cardiometabolic criteria on the pathogenesis of MASLD and diagnostic performance of non-invasive tests

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Kazuhito Kawata,
  • Hirokazu Takahashi,
  • Taeang Arai,
  • Yuya Seko,
  • Takeshi Chida,
  • Hidenao Noritake,
  • Hidenori Toyoda,
  • Hideki Hayashi,
  • Kanji Yamaguchi,
  • Michihiro Iwaki,
  • Masato Yoneda,
  • Toshihide Shima,
  • Hideki Fujii,
  • Asahiro Morishita,
  • Kengo Tomita,
  • Miwa Kawanaka,
  • Yuichi Yoshida,
  • Tadashi Ikegami,
  • Kazuo Notsumata,
  • Satoshi Oeda,
  • Masanori Atsukawa,
  • Yoshihiro Kamada,
  • Yoshio Sumida,
  • Hideaki Fukushima,
  • Eiji Miyoshi,
  • Shinichi Aishima,
  • Takeshi Okanoue,
  • Yoshito Itoh,
  • Atsushi Nakajima

摘要

Background

The impact of each factor and the number of positive criteria on pathogenesis and the diagnostic performance of non-invasive tests (NITs) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. This study aimed to investigate the association between the cardiometabolic criteria and the clinical features.

Methods

This retrospective study investigated clinicopathological characteristics and the diagnostic performance of the Enhanced Liver Fibrosis (ELF) test, fibrosis-4 (FIB-4) index, and nonalcoholic fatty liver disease fibrosis score (NFS) according to the factors and the number of positive cardiometabolic criteria in 1,038 patients with biopsy-proven MASLD.

Results

Hypertension is a significant risk factor for progression to advanced fibrosis and at-risk metabolic dysfunction-associated steatohepatitis (MASH) in male patients. In contrast, no significant risk factor was identified in female patients. The incidence of advanced fibrosis increased significantly in patients with three or more positive criteria. Similarly, the incidence of at-risk MASH increased significantly in a stepwise manner with the number of positive cardiometabolic criteria. The diagnostic performance of the ELF test for advanced fibrosis exceeded that of the FIB-4 index and NFS for all factors except hypertension. Regardless of the number of positive cardiometabolic criteria, the ELF test demonstrated a superior diagnostic performance for advanced fibrosis.

Conclusions

MASLD with hypertension in male patients or a higher number of positive cardiometabolic criteria constitutes a significant risk for advanced fibrosis or at-risk MASH. The ELF test is a valuable tool for diagnosing advanced fibrosis progression regardless of individual factors or the number of positive cardiometabolic criteria.