Liver and Bile
Gut. 2024;73(8):1343–9
MASH Resolution Index: Development and validation of a non-invasive score to detect histological resolution of MASH
Background: Dynamic changes in non-invasive tests, such as changes in alanine aminotransferase (ALT) and magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF), may help to detect metabolic dysfunction-associated steatohepatitis (MASH) resolution, but a combination of non-invasive tests may be more accurate than either alone. The authors developed a novel non-invasive score, the MASH Resolution Index, to detect the histological resolution of MASH. Methods: This study included a derivation cohort of 95 well-characterised adult participants (67% female) with biopsy-confirmed MASH who underwent contemporaneous laboratory testing, MRI-PDFF and liver biopsy at 2 time points. The primary objective was to develop a non-invasive score to detect MASH resolution with no worsening of fibrosis. The most predictive logistic regression model was selected based on the highest area under the receiver operating curve (AUC), and the lowest Akaike information criterion and Bayesian information criterion. The model was then externally validated in a distinct cohort of 163 participants with MASH from a clinical trial. Results: The median (interquartile range [IQR]) age and body mass index were 55 (IQR, 45–62) years and 32.0 (IQR, 30–37) kg/m2, respectively, in the derivation cohort. The most accurate model (MASH Resolution Index) included MRI-PDFF, ALT and aspartate aminotransferase (AST). The index had an AUC of 0.81 (95% confidence interval [CI]: 0.69–0.93) for detecting MASH resolution in the derivation cohort. The score calibrated well and performed robustly in a distinct external validation cohort (AUC, 0.83; 95% CI: 0.76–0.91), and outperformed changes in ALT and MRI-PDFF.
Conclusion: The Metabolic Dysfunction-Associated Steatohepatitis (MASH) Resolution Index may be a useful score to non-invasively identify MASH resolution.