Sistema de Salut de Catalunya
Institut Català de la Salut
[Isaza SC, Fernández-García CE] Metabolic Syndrome and Vascular Risk Laboratory, Hospital Universitario Santa Cristina, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain. [Rojo D, Pagés L] Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca de Malalties Hepàtiques, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain. [Iruzubieta P] Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain. Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Santander, Spain. [Ampuero J] SeLiver Group, Instituto de Biomedicina de Sevilla/CSIC/Hospital Virgen del Rocío, Sevilla, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. [Aller R] Servicio A Digestivo Hospital Clínico Universitario Valladolid, Universidad de Valladolid, Biocritic, Valladolid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain. [Pericàs JM] Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca de Malalties Hepàtiques, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
Vall d'Hebron Barcelona Hospital Campus
2026-03-04T13:41:05Z
2026-03-04T13:41:05Z
2025-11-19
Advanced liver fibrosis; Non-invasive diagnosis; Validation
Fibrosis hepática avanzada; Diagnóstico no invasivo; Validación
Fibrosi hepàtica avançada; Diagnòstic no invasiu; Validació
Liver fibrosis represents the main risk factor not only for liver-related but also for overall mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) patients, being metabolic dysfunction-associated steatohepatitis (MASH) its more severe clinical form. We recently developed a non-invasive algorithm termed BMP8A Fibrosis Score (BFS) which is able to identify MASH patients with advanced liver fibrosis. The aim of this study was to validate the BFS comparing its diagnostic accuracy with that of other scoring systems developed to assess liver fibrosis in MASH patients. Serum BMP8A was measured in 302 patients with biopsy-proven MASH: 171 with non- or mild fibrosis (F0-F2) and 131 with advanced fibrosis (F3-F4) recruited from seven university hospitals located in different cities in Spain. BFS, Fibrosis-4 (FIB-4) Index, NAFLD Fibrosis Score (NFS), Hepamet Fibrosis Score (HFS), and AST-to-Platelet Ratio Index (APRI) were calculated for each patient. The diagnostic accuracy of the scoring systems was determined according to the area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and likelihood ratios (LR). BFS showed higher overall accuracy than the other liver fibrosis algorithms calculated in the study cohort, presenting an AUROC of 0.750 for predicting advanced liver fibrosis (F3-F4), and correctly classifying 70.9% of F3-F4 patients with a sensitivity of 58.0%, a specificity of 80.7%, a 71.5% NPV, a 69.7% PPV, a 3.0 LR+, and a 0.5 LR-; the other predictive scores correctly classified a lower percentage of these patients (63.6% for FIB-4 ≥ 2.67, 63.2% for HFS ≥ 0.47, 57.3% for APRI ≥ 1.5 and 56.9% for NFS ≥ 0.675). BFS eliminates the grey area as it uses a single cut-off value (0.46), which is its key advantage over the others, reducing the number of patients with undetermined results (43.4% for FIB-4, 39.1% APRI, 37.4% for HFS, and 24.1% NFS). In sum, BFS properly classified more patients with advanced liver fibrosis (F3-F4) than the other scoring systems, eliminating indeterminate results and improving risk stratification.
This work was supported by NIT NASH grant from Pfizer.
Article
Published version
English
Cirrosi hepàtica - Diagnòstic; Esteatosi hepàtica - Diagnòstic; Esteatosi hepàtica - Mortalitat; Cirrosi hepàtica - Mortalitat; DISEASES::Digestive System Diseases::Liver Diseases::Fatty Liver::Non-alcoholic Fatty Liver Disease; DISEASES::Digestive System Diseases::Liver Diseases::Liver Cirrhosis; Other subheadings::Other subheadings::/diagnosis; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors; DISEASES::Digestive System Diseases::Liver Diseases::Fatty Liver; Other subheadings::Other subheadings::Other subheadings::Other subheadings::/mortality; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hígado graso::esteatosis hepática no alcohólica; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::cirrosis hepática; Otros calificadores::Otros calificadores::/diagnóstico; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::estadística como asunto::probabilidad::riesgo::factores de riesgo; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hígado graso; Otros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::diseño de la investigación epidemiológica::sensibilidad y especificidad::valor predictivo de las pruebas
BMC
Biomarker Research;13
https://doi.org/10.1186/s40364-025-00862-3
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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