Thank you for honoring Dr.Harrison in your presentation. His vision and dedication continue to inspire us all as we advance in our work on MASH/MASLD. Grateful for your insights and leadership. #PinnacleProud
Meena Bansal is the third speaker today with excellent back to back presentations: Cracking the Code: Making the Diagnosis, Risk Stratification, and Prognosis Prediction in MASLD/MASH and The Clues Within: Overview of Serum Markers of Liver Fibrosis and Metabolic Health. "One important outcome of the new nomenclature is the designation of met-ALD". MASH is a hepatic manifestation of metabolic syndrome. Work-up for Abnormal Liver Enzymes: True healthy normal ALT 29-33 IU/L for Males 19-25 IU/L for Females Rule out other etiologies of chronic liver disease and drugs induced liver injury Ultrasound Incidental Hepatic Steatosis on Routine Imaging reflects Moderate Severe Steatosis Ultrasound 100% Sensitivity; 90% Sensitivity to detect >20% Macrovesicular Steatosis Meta-Analysis: 85% Sensitivity and Specificity for Moderate-Severe Steatosis (>30% Steatosis) CT scan 100% Sensitivity; 95% Specificity for Moderate-Severe Fibrosis Drives Outcomes in MASLD "On average it takes about 30 years to develop cirrhosis, but we do have rapid progressors - could be genetic differences. Social determinants of health, pollutants, coffee, and others all impact speed of disease course." Who has the highest risk of fibrosis? Estimated Prevalence in High-Risk Groups • Diabetes Mellitus 55-70% MASLD/NAFLD 30-40% MASH/NASH 20% of patients with advanced fibrosis • Obesity 55-90% MASLD/NAFLD 25-30% MASH/NASH 15% with advanced fibrosis • HIV 35% MASLD/NAFLD 42% MASH/NASH Increasing SAFE scores correlated with shorter overall survival (not with liver-specific outcomes) with an adjusted HR of 1.53 ( p < 0.01) for subjects with SAFE > 100. Screening for Advanced Fibrosis in At-Risk Populations Argument for a Quality Measure Focus on Diabetes - Clear Denominator - Attributed patient population in Value-Based Contracts - Existent Measures for End Organ Damage from Diabetes Nephropathy, Retinopathy - 28% of Medicare Population has Diabetes - NCQA Diabetes Recognition Program - FIB-4 Readily Available with no significant incremental cost Take home points - Steatotic Liver Disease - MASLD is the new NAFLD/ MASH is the new NASH - Screen at-risk population with simple FIB-4 followed by VCTE or ELF Diabetic Hepatopathy - NITs can reasonably identify at-risk MASH, predict progression to cirrhosis, and liver related outcomes - Those with F2 or greater fibrosis have > ~10 fold increased risk of liver related mortality Consider Resmetirom for F2/F3 Enroll in Clinical Trials HCC Screening for American Association for the Study of Liver Diseases (AASLD), EASL | The Home of Hepatology, Barcelona Institute for Global Health (ISGlobal), Global Liver Institute, European Liver Patients' Association - ELPA, LPI LIVER PATIENTS INTERNATIONAL, Canadian Association for the Study of the Liver
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