Using a Database Analysis to Determine Alignment Between Physician-Reported and Objectively Derived Fibrosis Scores for US Patients With Metabolic Dysfunction-Associated Steatohepatitis (MASH)

OBJECTIVES: Accurate fibrosis risk stratification in metabolic dysfunction-associated steatohepatitis (MASH) is critical for effective disease management. This study aimed to determine whether physicians’ classifications of fibrosis scores using existing clinical data are aligned with objectively derived measures from noninvasive tests, such as vibration controlled transient elastography and Fibrosis-4 index, in patients with MASH (PwM).

METHODS: Data were drawn from the 2022 Adelphi Real World MASH Disease Specific Programme™, a cross-sectional secondary database of US physicians and PwM. Eligible physicians provided patient demographics, clinical characteristics, fibrosis stages, and laboratory results. For physician-reported and objectively derived scores, PwM were categorized into no/early, advanced fibrosis, and undetermined/unknown. Descriptive statistics assessed the alignment in fibrosis scores and a logistic regression analysis identified factors associated with misalignment.

RESULTS: Of 832 PwM, physicians (n=85) classified 60.1% as no/early fibrosis (F0-F2), 28.8% as advanced fibrosis (F3-F4), and 11.1% as undetermined/unknown. Among 535 PwM with both physician-reported and objective scores, 88.1% were aligned. Alignment within the no/early and advanced fibrosis groups was 90.2% (n=330/366) and 83.4% (n=141/169), respectively. Physicians overestimated no/early fibrosis in 6.7% (n=36/535) and underestimated advanced fibrosis in 5.2% (n=28/535) of PwM. Significant factors associated with misalignment included BMI >30 kg/m² (odds ratio=2.07, 95% confidence interval: 1.07-3.99), age >50 years (3.05, 1.56-5.95), and difficulty in determining the need for liver biopsy (5.07, 1.70-15.1).

CONCLUSIONS: While most physician-reported and objective scores aligned, a proportion of US physicians faced challenges with risk stratification in PwM. Misalignment was more likely in older patients, those with obesity, and physicians who reported difficulty in determining the need for liver biopsy. Highlighting these factors may help prevent misalignment when risk stratifying which may lead to earlier intervention and better disease management.