Citations 2
Global multicenter validation of noninvasive fibrosis assessment pathways in MetALD and ALD
Gu, Hyundam , Diaz, Luis Antonio, Baeza, Natalia, Idalsoaga, Francisco, Zheng, Ming‐Hua , Maiwall, Rakhi , Sarin, Shiv K., Kulkarni, Anand V., Ramyasri, Ramagundam, Tijera, Fátima Higuera de La, Pinto, Helena , Carvalhana, Sofia, Fernandes, Rita , Khan, Mohammad Qasim , Alazawi, William, Li, Wenhao, Temperley, Laura , Marti-Aguado, David, Gratacós-Ginès, Jordi, Montes, Pedro, Yip, Terry Cheuk‐Fung , Wong, Vincent Wai-Sun, Villela-Nogueira, Cristiane, Leite, Nathalie, Salles, Gil F. , Cardoso, Claudia Regina Lopes, Contreras, Daniza, Galimberti, Alceo, Bessone, Fernando, Valentin-Cortez, Francisco J , Mijangos-Trejo, Alejandra, Chavéz-Tapia, N, Simian, Daniela , Gil, Pamela, Mattos, Ângelo, Acuña, Johana , Araujo, Roberta Chaves, Ferraz, Igor Lima, Marrugo, Katherine, Torres, A , Torres, Juan Diego , Valdes, V., Córdova, Jacqueline, Mendizabal, Manual, Couto, Cláudia Alves , Cotter, Thomas G., Anouti, Ahmad , Rady, Elias D. , Patel, Sheel , Singal, Ashwani K., Parker, Richard, Ibrahim, Mohamad Ali , Jalal, Prasun K., Noureddin, Mazen, Alkhouri, Naim , Kamath, Patrick S. , Sanyal, Arun, Sterling, Richard K., Ajmera, Veeral, Loomba, Rohit, Arrese, Marco, Bataller, Ramón , Arab, Juan Pablo, Jalal, Prasun K , Cuyas, Berta , Cheuk-Fung Yip, Terry , Zheng, Ming-Hua , Díaz, Luis Antonio , Baeza, Natalia , Idalsoaga, Francisco , Zhou, Xiao-Dong , Sarin, Shiv Kumar , Kulkarni, Anand V., Ramyasri, Ramagundam, Carvalhana, Sofia , Alazawi, William , Li, Wenhao , Aguado, David Martí , Gratacós‐Ginès, Jordi , Pose, Elisa , Poca, María , Cuyàs, Berta , Barreyro, Fernando Javier , Ayares, Gustavo , Wong, Vincent Wai‐Sun , Wong, Grace Lai‐Hung , Lai, Jimmy Che‐To , Cardoso, Claudia R.L. , Velasco, J.A. Velarde-Ruiz , Galimberti, Alceo, Bessone, Fernando , Chávez-Tapia, Norberto Carlos , Ridruejo, Ezequiel , Peralta, Mirta , Roblero, Juan Pablo , El‐Kassas, Mohamed , Araújo, Roberta Chaves , Marrugo, Katherine , Mendizabal, Manuel , Cançado, Guilherme Grossi Lopes , Cotter, T G , Dahshi, Hamza , Singal, Ashwani K. , Pekarska, Katrīna , Jalal, Prasun K. , Castro-Narro, Graciela E , Noureddin, Mazen , Dunn, Winston , Sanyal, Arun J. , Sterling, Richard K. , Ajmera, Veeral , Loomba, Rohit , Arrese, Marco , Arab, Juan Pablo
Hepatology Communications | July 28, 2026 | Volume: 10 | Issue: 8 | Pages: No page available
Background: Noninvasive tests are well validated in metabolic dysfunction–associated steatotic liver disease, but evidence in metabolic dysfunction and alcohol-associated liver disease (MetALD) and alcohol-associated liver disease (ALD) is limited. We evaluated noninvasive test–based clinical care pathways for fibrosis risk stratification in MetALD and ALD. Methods: This is a multinational, multicenter, cross-sectional study across 35 centers in 16 countries (2013–2025), including adults with MetALD or ALD. Fibrosis was assessed by liver biopsy and/or vibration-controlled transient elastography (VCTE). In biopsy-proven participants, we analyzed the sequential pathway (Fibrosis-4 [FIB-4] first, followed by VCTE for indeterminate FIB-4) to identify advanced fibrosis (≥F3). Diagnostic accuracy was assessed using the AUC. Results: Among 893 participants (41.3% MetALD and 58.7% ALD), the median age was 52 [43.0–61.0] years, and 79.4% were male. The estimated prevalence of advanced fibrosis was 45% (32.2% in MetALD and 54.0% in ALD). Participants with MetALD had a more dysmetabolic profile but lower fibrosis stages than ALD. Among biopsy-proven participants, FIB-4 AUC was 0.720, and VCTE AUC was 0.833. FIB-4 performed better in MetALD than ALD (AUC 0.773 vs. 0.540), while VCTE accuracy was similar across groups. In the sequential pathways, the false-negative rate for advanced fibrosis (misclassified as low risk) was 6.8% (4.9% MetALD and 11.3% ALD). Conclusions: In biopsy-proven patients, FIB-4 performance was acceptable in MetALD but substantially weaker in ALD. The standard 2-step pathway performed adequately in MetALD but missed a clinically meaningful proportion of advanced fibrosis in ALD.
Exploring the interaction between metabolic dysfunction and alcohol-associated hepatitis: A global study
Cari, Vania , Pérez, María Ignacia , Tellez, Ignacio , Idalsoaga, Francisco, Valsan, Arun , Nair, Gowripriya , Soni, Kriti , Rhoads, S. Fisher , Arnold, Jorge , Ayala-Valverde, Maria, Ramirez-Cadiz, Carolina, Jalal, Prasun K., Ibrahim, Mohamad Ali , Elfeki, Mohamed A., Simian, Daniela , Córdova, Jacqueline, Higuera‐de‐la‐Tijera, Fátima , Silva, Rita, Rocha, Cristina Melo , Araujo, Roberta C., Fontani, Guilherme Massote, Pereira, Gustavo Henrique, Bessone, Fernando, Tanno, Mario, Kisch, Ayelen, Mendizabal, Manual, Marciano, Sebastian, Gomez-Perdiguero, Gonzalo, Montes, Pedro, Salazar, Patricia Guerra, Ramos, Geraldine, Chacko, Kristina R., Skladaný, Lubomir, Maiwall, Rakhi, SIMONETTO, DOUGLAS, Sanyal, A, Shah, Vijay H. , Singal, Ashwani K., Dunn, Winston, Kamath, Patrick S., Loomba, R, Arrese, Marco, Bataller, Ramon, Diaz, Luis Antonio, Arab, Juan Pablo, Elfeki, Mohamed A. , Perez, María I , Idalsoaga, Francisco , Ayala-Valverde, María , Ramirez-Cadiz, Carolina , Jalal, Prasun K , Ibrahim, Mohamad A , Elfeki, Mohamed A , Roblero, Juan P , Simian, Daniela , Velarde-Ruiz Velasco, José Antonio , Cordova-Gallardo, Jacqueline , Higuera-De La Tijera, Fatima , Silva, Rita , Fontani, Guilherme M , Bessone, Fernando , Mendizabal, Manuel , Marciano, Sebastián , Gomez-Perdiguero, Gonzalo , Montes, Pedro , Guerra Salazar, Patricia , Chacko, Kristina R , Simonetto, Douglas A , Sanyal, A J , Singal, Ashwani K , Dunn, Winston , Kamath, Patrick S , Loomba, Rohit , Bataller, Ramon A , Díaz, Luis A , Gormaz, Vania Cari, Téllez, Ignacio García, Idalsoaga, Francisco , Rhoads, Fisher, Ayala-Valverde, María , Jalal, Prasun K. , Roblero, Juan Pablo , Velasco, J.A. Velarde-Ruiz , Araújo, Roberta Chaves , Massote, Guilherme Fontanini, Pereira, Gustavo , Chacko, Kristina R. , Maiwall, Rakhi , Simonetto, Douglas A. , Sanyal, Arun J. , Singal, Ashwani K. , Dunn, Winston , Kamath, Patrick S. , Loomba, Rohit , Arrese, Marco , Díaz, Luis Antonio , Arab, Juan Pablo
Hepatology | May 6, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Introduction: Although the role of cardiometabolic risk factors (CMRF) has been characterized in steatotic liver disease, their role in the severity of alcohol-associated hepatitis (AH) remains unclear. We aimed to evaluate the impact of CMRF on mortality. Methods: Multinational prospective cohort study (2015–2024) including hospitalized patients with severe AH across 32 centers in 14 countries. Diagnosis of AH was made using the NIAAA criteria. Analyses included adjusted competing-risk models by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroid use, MELD, and ACLF grade, with liver transplantation as a competing risk. Results: 936 participants were included; mean age 48±11.2 years, and 88.9% were male. At least one CMRF was present in 46.6%; median body mass index (BMI) was 24.2 kg/m 2 [IQR: 22.8–28.2], prevalence of diabetes 17.6%, hypertension 16.5%, and dyslipidemia 5.8%. Median MELD was 24.4 [19.3–31.4], 86.7% had severe AH, and 180-day survival was 72.9%. Survival did not differ by CMRF status (log-rank p =0.453). In adjusted competing-risk models, higher age (sHR 1.02; 95%CI:1.01–1.04), greater alcohol intake (per g/day; sHR 1.001; 95%CI:1.000–1.002), MELD (sHR 1.04; 95%CI:1.01–1.06), and ACLF grade 2–3 (sHR 2.34 and 4.34) predicted mortality. However, no individual CMRF independently increased mortality. A prespecified non-linear BMI analysis showed modestly lower mortality between 25–40 kg/m², with a higher risk above 40 kg/m². Conclusion: Among patients with severe AH, metabolic dysfunction was not associated with increased mortality. Although a higher BMI was associated with slightly lower mortality in AH, this may reflect better nutritional status rather than a true protective effect.