There is an unmet need for non-invasive tests to improve case-finding and aid primary care professionals in referring patients at high risk of liver disease. A metabolic dysfunction-associated fibrosis (MAF-5) score was developed and externally validated in a total of 21,797 individuals with metabolic dysfunction, in population-based (NHANES2017-2020, NHANESIII, Rotterdam Study) as well as hospital-based cohorts (from Antwerp and Bogota). Fibrosis was defined as liver stiffness (LSM)≥8.0kPa. Diagnostic accuracy was compared to FIB-4, NFS and SAFE. MAF-5 was externally validated with LSM≥8.0kPa, with shear-wave elastography (SWE≥7.5 kPa) and biopsy-proven steatotic liver disease according to METAVIR and NASH-CRN scores, and was tested for prognostic performance (all-cause mortality). The MAF-5 score comprised waist circumference, BMI, diabetes, AST and platelets. With this score, 60.9% was predicted at low, 14.1% at intermediate and 24.9% at high risk of fibrosis. The observed prevalence was 3.3%, 7.9% and 28.1%, respectively. The AUROC of MAF-5 (0.81) was significantly higher than FIB-4 (0.61), and outperformed the FIB-4 among the young (NPV 99% [AUC 0.86] versus 94% [AUC 0.51]) and elderly (NPV 94% [AUC 0.75] versus 88% [AUC 0.55]). MAF-5 showed excellent performance to detect LSM≥12kPa (AUC 0.86 training, AUC 0.85 validation) and good performance in detecting liver stiffness and biopsy-proven liver fibrosis among the external validation cohorts. MAF-5 score>1 was associated with increased risk of all-cause mortality in (un)adjusted models (aHR:1.59, 95%CI:1.47–1.73). The MAF-5 score is a validated, age-independent, inexpensive referral tool to identify individuals at high risk of liver fibrosis and all-cause mortality in primary care populations, using simple variables.

中文翻译：

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MAF-5 预测代谢功能障碍一般人群的肝纤维化风险和结果

对非侵入性检测的需求尚未得到满足，以改善病例发现并帮助初级保健专业人员转诊肝病高风险患者。代谢功能障碍相关纤维化 (MAF-5) 评分在基于人群（NHANES2017-2020、NHANESIII、鹿特丹研究）以及基于医院的队列（来自安特卫普和波哥大）。纤维化定义为肝硬度（LSM）≥8.0kPa。诊断准确性与 FIB-4、NFS 和 SAFE 进行了比较。 MAF-5 通过 LSM≥8.0kPa、剪切波弹性成像 (SWE≥7.5 kPa) 和根据 MEAVIR 和 NASH-CRN 评分活检证实的脂肪变性肝病进行了外部验证，并测试了预后性能（全因死亡率） ）。 MAF-5评分包括腰围、BMI、糖尿病、AST和血小板。根据该评分，预测 60.9% 为低纤维化风险，14.1% 为中度纤维化风险，24.9% 为高纤维化风险。观察到的患病率分别为 3.3%、7.9% 和 28.1%。 MAF-5 的 AUROC (0.81) 显着高于 FIB-4 (0.61)，并且在年轻人 (NPV 99% [AUC 0.86] 对比 94% [AUC 0.51]) 和老年人 (NPV 94) 中表现优于 FIB-4 % [AUC 0.75] 与 88% [AUC 0.55]）。 MAF-5 在检测 LSM≥12kPa 方面表现出优异的性能（AUC 0.86 训练，AUC 0.85 验证），并且在外部验证队列中检测肝脏硬度和活检证实的肝纤维化方面表现出良好的性能。在（未）调整模型中，MAF-5 评分 >1 与全因死亡率风险增加相关（aHR：1.59，95% CI：1.47–1.73）。 MAF-5 评分是一种经过验证、与年龄无关、廉价的转诊工具，可使用简单的变量来识别初级保健人群中肝纤维化和全因死亡率高风险的个体。