Background & Aims: Cut-points for non-invasive tests (NITs) for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD) were derived from predominantly non-Hispanic populations. It is unknown if these cut-points perform adequately in Hispanic individuals. We assessed the performance characteristics of current NIT cut-points among Hispanic patients and determined whether they could be further optimized. Approach & Results: We prospectively enrolled 244 adults with biopsy-proven MASLD. Participants underwent a research visit with magnetic resonance elastography (MRE) and vibration controlled transient elastography (VCTE). Histology and imaging assessments were conducted centrally. Diagnostic performance was evaluated by area under the receiver-operating curve (AUROC) and optimal cut-points were identified by Youden J analysis. The mean (±SD) age and body mass index were 52.6 (±13) and 31.6 (±4.6) kg/m2. Overall, 40% had diabetes, 31% (N=75) were Hispanic. 40% of Hispanic and 28.4% of non-Hispanic patients had significant fibrosis. To detect significant fibrosis, MRE and VCTE exhibited significantly lower accuracy in Hispanic versus non-Hispanic participants (AUROC: MRE, 0.87 vs. 0.98, p=0.01; VCTE, 0.78 vs. 0.92, p=0.02). Clinical care algorithms yielded high false-negative rates among Hispanic participants (14% with low-risk FIB-4 and 21% with low-risk VCTE had advanced fibrosis on biopsy). Cut-points of 2.73 kPa for MRE and 6.9 kPa for VCTE were optimal to detect significant fibrosis in Hispanic individuals. Findings were validated in a Latin American cohort. Conclusions: Lower NIT cut-points may be needed to optimize surveillance for significant fibrosis due to MASLD in Hispanic populations commensurate with their higher burden and severity of disease.

中文翻译：

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患有代谢功能障碍相关脂肪性肝病的西班牙裔成人的筛查和风险分层的差异


背景和目标：代谢功能障碍相关脂肪性肝病（MASLD）中风险分层的非侵入性测试（NIT）的切点主要来自非西班牙裔人群。目前尚不清楚这些切点在西班牙裔个体中是否表现良好。我们评估了西班牙裔患者当前 NIT 切点的性能特征，并确定它们是否可以进一步优化。方法和结果：我们前瞻性地招募了244名经活检证实的MASLD成年人。参与者接受了磁共振弹性成像 （MRE） 和振动控制瞬态弹性成像 （VCTE） 的研究访问。组织学和影像学评估集中进行。通过受试者工作曲线下面积 （AUROC） 评估诊断性能，并通过 Youden J 分析确定最佳切点。平均 （±SD） 年龄和体重指数分别为 52.6 （±13） 和 31.6 （±4.6） kg/m2。总体而言，40% 患有糖尿病，31% （N=75） 是西班牙裔。40% 的西班牙裔患者和 28.4% 的非西班牙裔患者有明显的纤维化。为了检测显着纤维化，MRE 和 VCTE 在西班牙裔参与者中的准确性显著低于非西班牙裔参与者（AUROC：MRE，0.87 vs. 0.98，p=0.01;VCTE，0.78 vs. 0.92，p=0.02）。临床护理算法在西班牙裔参与者中产生了很高的假阴性率 （14% 的低风险 FIB-4 和 21% 的低风险 VCTE 在活检中患有晚期纤维化）。MRE 的 2.73 kPa 和 VCTE 的切点为 6.9 kPa 是检测西班牙裔个体显着纤维化的最佳。研究结果在拉丁美洲队列中得到了验证。 结论：可能需要较低的 NIT 切点来优化西班牙裔人群中 MASLD 引起的显着纤维化的监测，这与他们较高的疾病负担和严重程度相称。