@article{10902/33032,
year = {2024},
url = {https://hdl.handle.net/10902/33032},
abstract = {Background: MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern. Objective: To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis. Methods: Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H),>5; (b) mixed pattern(M),2-5; (c) cholestatic pattern(C),<2. Outcomes: (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death. Results: Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H vs. 41.9% M vs. 31.9% C) were more common in H-pattern (p=0.0001),whilst C-pattern was linked to cirrhosis (5.8% H vs. 5.6% M vs. 10.9% C; p=0.0001). FIB-4(0.74(95% CI 0.69-0.79) vs. 0.83 (95% CI 0.80-0.85); p=0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69-0.85) vs. 0.84 (95% CI 0.80-0.87); p=0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12-5.02); p=0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation. Conclusions: The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.},
organization = {Funding: Funding for open access publishing: Universidad de Sevilla/ CBUA. JA is funded by the “Spanish Ministry of Economy, Innovation and Competition, Instituto de Salud Carlos III” (PI19/01404, PI22/01345, and GLD19/00100). JMB is funded by Spanish Carlos III Health Institute (ISCIII) (FIS PI18/01075, PI21/00922 and Miguel Servet Program CPII19/00008) cofnanced by “Fondo Europeo de Desarrollo Regional” (FEDER), Department of Health of the Basque Country (2017111010, 2020111077), “Euskadi RIS3” (2022333032), La Caixa Scientifc Foundation (HR17-00601), European Union’s Horizon 2020 Research and Innovation Program (grant number 825510, ESCALON). PA is funded by Gobierno Vasco IT1476-22; MCIU/AEI/ FEDER, UE (PDI2021-124425OB-I00). *The funders have not had any role in the design, analysis, writing, or interpretation of this project.},
publisher = {Springer Nature},
publisher = {Journal of Gastroenterology, 2024},
title = {The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis},
author = {Ampuero, Javier and Aller, Rocío and Crespo García, Javier and Calleja, José Luis and García-Monzón, Carmelo and Gómez-Camarero, Judith and Caballería, Joan and Lo Iacono, Oreste and Ibáñez, Luis and García-Samaniego, Javier and Albillos, Agustín and Francés, Rubén and Fernández-Rodríguez, Conrado and Maya-Miles, Douglas and Diago, Moisés and Poca, María and Andrade, Raúl J. and Latorre, Raquel and Jorquera, Francisco and Morillas, Rosa María},
}