Disparities in screening and risk stratification for Hispanic adults with metabolic dysfunction–associated steatotic liver disease
Monica A. Tincopa, Luis Antonio Díaz, Daniel Q. Huang, Juan Pablo Arab, Marco Arrese, Adrian Gadano, Cláudia P. Oliveira, Richele Bettencourt, Egbert Madamba, Susy Kim, Harris Siddiqi, Fernando Javier Barreyro, Sebastián Marciano, Jorge Martínez Morales, Cristiane Alves Villela‐Nogueira, Nathalie C. Leite, Cláudia Alves Couto, Rafael Theodoro, Mísia Joyner de Sousa Dias Monteiro, Mário Guimarães Pessôa, Mario Reis Alvares-da-Silva, Fatima Higuera‐de la Tijera, Constanza D. Sabate, Manuel Mendizábal, L. Richards, Claude B. Sirlin, Rohit S. Loomba
Abstract
BACKGROUND AND AIMS: Cut-points for noninvasive tests for risk stratification in metabolic dysfunction-associated steatotic liver disease were derived from predominantly non-Hispanic populations. It is unknown if these cut-points perform adequately in Hispanic individuals. We assessed the performance characteristics of current noninvasive test cut-points among Hispanic patients and determined whether they could be further optimized. APPROACH AND RESULTS: We prospectively enrolled 244 adults with biopsy-proven metabolic dysfunction-associated steatotic liver disease. Participants underwent a research visit with magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE). Histology and imaging assessments were conducted centrally. Diagnostic performance was evaluated by AUROC and optimal cut-points were identified by Youden J analysis. The mean (±SD) age and body mass index were 52.6 (±13) and 31.6 (±4.6) kg/m 2 . Overall, 40% had diabetes, and 31% (N = 75) were Hispanic. Forty percent of Hispanic and 28.4% of non-Hispanic patients had significant fibrosis. To detect significant fibrosis, MRE and VCTE exhibited significantly lower accuracy in Hispanic versus non-Hispanic participants (AUROC: MRE, 0.87 vs. 0.98, p = 0.01; VCTE, 0.78 vs. 0.92, p = 0.02). Clinical care algorithms yielded high false-negative rates among Hispanic participants (14% with low-risk fibrosis-4 index and 21% with low-risk VCTE had advanced fibrosis on biopsy). Cut-points of 2.73 kPa for MRE and 6.9 kPa for VCTE were optimal for detecting significant fibrosis in Hispanic individuals. Findings were validated in a Latin American cohort. CONCLUSIONS: Lower noninvasive test cut-points may be needed to optimize surveillance for significant fibrosis due to metabolic dysfunction-associated steatotic liver disease in Hispanic populations commensurate with their higher burden and severity of disease.