Disparities in screening and risk stratification for Hispanic adults with metabolic dysfunction-associated steatotic...

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.

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.

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.