Noninvasive identification of metabolic dysfunction–associated steatohepatitis (INFORM MASH): a retrospective cohort and disease modeling study

Using common clinical parameters, we aimed to noninvasively identify and predict metabolic dysfunction–associated steatohepatitis (MASH)/MASH with clinically significant fibrosis. Patients aged ≥18 with electronic health record (EHR) documented liver function tests and liver biopsies between 2016 and 2021 were retrospectively identified from the Geisinger Health System Research Liver Registry. MASH cases were confirmed using the nonalcoholic fatty liver disease (NAFLD) activity score. Training and validation datasets were used to create an algorithm/predictive model assessing EHR-derived predictors of MASH/MASH with clinically significant fibrosis (fibrosis stage F2–F4). Predictive accuracy was evaluated using the area under the curve. The analysis included 2698 patients. We created a composite likelihood score using variables significant for MASH and/or MASH with clinically significant fibrosis: liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST]), prior year AST, metabolic disease, pulse (heart rate), and body mass index. The score had higher sensitivity and specificity for predicting MASH than Fibrosis-4 (FIB-4) Index, AST to platelet ratio index (APRI), and NAFLD fibrosis score (NFS); sensitivity and specificity were comparable to FIB-4 and APRI for predicting MASH with clinically significant fibrosis but superior to NFS. The composite likelihood score could potentially be a tool for early MASH screening. Metabolic dysfunction–associated steatohepatitis (MASH) is the more severe form of metabolic dysfunction–associated steatotic liver disease (MASLD). These are common liver diseases that often affect people with other diseases related to the body’s metabolism, such as obesity and type 2 diabetes. These conditions cause fat to build up in the liver and can cause inflammation and scarring (fibrosis). MASH is challenging to detect because there are often no symptoms. MASH is most often diagnosed by a liver biopsy, where tissue is taken from the liver for testing, which can be uncomfortable and expensive. We aimed to create a scoring tool based on information commonly collected during regular healthcare visits. The scoring system assessed a person’s likelihood of having MASH or MASH with more advanced stages of liver scarring. To develop the scoring system, we used information from 2698 adult patients who received medical care at a large health system, had liver function tests in their medical records, and had a liver biopsy between 2016 and 2021. Using statistical models, we identified several items associated with MASH or the advanced stages of liver scarring. These included heart rate, body mass index, and liver enzymes; and if a person had type 2 diabetes, high blood pressure, or high cholesterol. We found that the likelihood score performed similarly to, or better than, three scoring systems commonly used in healthcare practice. Therefore, this scoring system may be another option for early screening of MASH, using information commonly available in patients’ medical records.