Citations 1
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.