ArticleAlimentary pharmacology & therapeutics2025
MetALD: Diagnosis and Prognosis With Non-Invasive Tests.
Article in Alimentary pharmacology & therapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Distinct Laboratory and Clinical Features of Metabolic and Alcohol-Related Liver Disease (MetALD): A Systematic Review and Meta-Analysis.Current obesity reports · 2026Pooled it
- The global burden of metabolic and alcohol-associated liver disease (MetALD).Hepatology communications · 2026Review
- Alcohol-aware risk stratification and subtype-specific care pathways across metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and alcohol-associated liver disease, and alcohol-associated liver disease.Clinical and molecular hepatology · 2026Review
- Steatotic liver disease: non-invasive assessment and biomarkers across metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatotic liver disease with moderate alcohol consumption and alcohol-associated liver disease.Clinical and molecular hepatology · 2026Review
- Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions.Clinical and molecular hepatology · 2026Review
- Blood-based non-invasive tests show comparable accuracy in MetALD and MASLD for MRE-defined advanced fibrosis.BMC gastroenterology · 2026Article
- Reply to: "Gene-environment "amplification" of liver stiffness requires more clinically meaningful analytic approaches".JHEP reports : innovation in hepatology · 2026Article
- Editorial: Implementing Risk Assessment Tools for MetALD in Clinical Practice.Alimentary pharmacology & therapeutics · 2025Article
- Fibrosis Severity in MASLD Determines the Predictive Value of Lp-PLA2 for Carotid Atherosclerosis in Type 2 Diabetes: A Cross-Sectional Study.Biomedicines · 2025Article
Corrections and comments
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Authors and funding
20 authors.
Funding
Abstract
backgroundNon-invasive tests (NITs) are central to diagnosing and stratifying risk in steatotic liver disease (SLD). However, it remains unclear whether guideline-recommended NIT cut-offs apply to metabolic and alcohol-related liver disease (MetALD).
aimEvaluate the diagnostic and prognostic performance of five NITs in patients with MetALD.
methodsSingle-centre study with 423 SLD patients, of whom 102 (24%) had MetALD. Patients were classified using histological or controlled attenuation parameter-defined hepatic steatosis and self-reported alcohol intake. We assessed the circulating markers of FIB-4, LiverRisk score, ELF and ADAPT together with transient elastography (TE) using established cut-offs for advanced fibrosis (≥ F3). Liver histology served as reference. Prognostic performance for hepatic decompensation and all-cause mortality was evaluated over a median follow-up of 62 months.
resultsAmong circulating NITs in MetALD, ELF and ADAPT both had the highest diagnostic accuracy (AUROC = 0.90), while it was lowest with LiverRisk score (AUROC = 0.74). The indeterminate zone between rule-out and rule-in cut-offs was largest for FIB-4 (34%). TE and circulating NIT concordance was highest for LiverRisk score (81%) to rule-out ≥ F3, and highest for ELF (88%) to rule-in ≥ F3. All included NITs predicted decompensation-free survival with their corresponding rule-out or rule-in cut-offs. A sequential 2-tier testing strategy (FIB-4 → TE) effectively stratified risk of decompensation. Incorporating a second-tier test (ELF or ADAPT) before TE reduced the number of TE referrals by 43% and 45%, without loss of prognostic performance.
conclusionWidely available NITs are applicable for MetALD, where cut-offs can be used to diagnose advanced fibrosis and predict clinical outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.