In adults with metabolic dysfunction, the MAF-5 score predicted risk for liver fibrosis (AUC range, 0.73 to 0.81)
The new Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) score could potentially identify patients in primary care who are at risk for progressive fibrosis and facilitate interventions and treatment, but it needs to be prospectively validated, an ACP Journal Club commentary said.
In a recent study, researchers developed and validated the Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) score to predict liver fibrosis risk using data from more than 20,000 adult patients with metabolic dysfunction. The score uses waist circumference (WC), body mass index (BMI), diabetes status, aspartate aminotransferase (AST) levels, and platelet count. Based on the MAF-5, 60.9% of patients were found to be at low risk of fibrosis, 14.1% at intermediate risk, and 24.9% at high risk, and scores were found to correlate with liver fibrosis and mortality risk.
The study was published by Gastroenterology on March 19. The following commentary by Jacob Korula, MD, was published in the ACP Journal Club section of Annals of Internal Medicine on Oct. 1.
The quest for predictive noninvasive tests (NITs) for hepatic fibrosis in patients with metabolic dysfunction has resulted in a new find: the MAF-5 score. In van Kleef and colleagues' study, a composite of AST, platelets, BMI, diabetes, and WC was shown to outperform other NIT contenders.
The study included 5 cohorts with heterogeneous patients from different countries over different time periods and used varied methods of measuring liver fibrosis (Fibroscan, shear wave elastography [SWE], and liver biopsies). Using area under the receiver-operating characteristic curves (AUCs), the MAF-5 score (AUC, 0.81) was superior to other NITs (AUC range, 0.61 to 0.74). Hazard ratios and Kaplan-Meier analysis showed that all-cause mortality was higher in the MAF-5 intermediate- and high-risk groups vs. the low-risk group. How do we interpret these results in a meaningful way?
Some study limitations need to be considered. Inclusion of a simple waist measurement for the score is less accurate than waist-to-hip ratios for women, who comprised most patients. BMI ranges for men and women differ, so gender-based stratification of BMI should have been used. The Rotterdam cohort had more patients with excessive alcohol use than the other cohorts so was not truly representative of patients with metabolic dysfunction. Most patients in 2 cohorts with comparisons between MAF-5 scores and liver biopsies had fibrosis scores ≤F2 (86% and 85%).
A meta-analysis showed a 10-fold higher technology failure rate with Fibroscans (11%) vs. SWE (0.8%), a factor that should be considered in interpreting the cohort data. The MAF-5 score was evaluated in selected populations across different time periods, which may add uncertainty to the results because disease definitions and diagnostic criteria and technology have changed over time.
Nevertheless, van Kleef and colleagues' effort to validate the MAF-5 score in large patient cohorts is impressive. The score has the potential to identify persons in primary care who are at risk for progressive fibrosis and facilitate interventions and treatment. The proof is in the pudding—prospective validation is needed.