Facteurs prédictifs d'une fibrose significative dans la maladie hépatique stéatosique associée à un dysfonctionnement métabolique

Abstract

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD), now recognized as one of the leading causes of chronic liver disease, affects more than 25% of the global population. The degree of fibrosis is the primary predictor of hepatic and extra-hepatic morbidity and mortality, becoming significant when fibrosis reaches or exceeds stage F2, a condition referred to as "At-risk MASH." AIM: To investigate factors contributing to fibrosis progression in patients with MASLD. METHODS: We carried out a retrospective study in the Hepato-Gastroenterology Department at Charles Nicolle Hospital in Tunisia from 2016 to 2022, including 202 patients with hepatic steatosis confirmed by abdominal ultrasoundwith at least one cardiometabolic risk factor. Fibrosis assessment was performed using FibroScan®. Significant fibrosis was defined as hepatic fibrosis ≥ F2.The association between various studied variables and significant fibrosis was assessed using the Chi-square test and Fisher's exact test. RESULTS: A total of 202 patients with MASLD were included. Their average age was 56.14±10.98 years, with a male-to-female ratio of 0.43. The average liver stiffness measurement was 7.36±7.18 kPa. The distribution of fibrosis stages was: F0-F1=79.7%, F2=5.4%, F3=5%, and F4=9.9%. In univariate analysis, several parameters were significantly associated with significant fibrosis (≥F2): older age (p=0.028), type 2 diabetes (p=0.03), hypertension (p=0.037), elevated levels of AST (p <0.001), ALT (p<0.001), GGT (p<0.001), and fasting glucose (p=0.047). Lower platelet count (p<0.001), prothrombin time (p=0.001), and albumin levels (p=0.039) were also significantly associated with significant fibrosis. In multivariate analysis, age >52 years, elevated GGT levels (>41 U/L), hypoalbuminemia (<39 g/L), and fasting glucose >2 g/L were independent predictive factors of significant fibrosis. CONCLUSION: Based on these findings, advanced age, elevated GGT, hypoalbuminemia, and increased fasting glucose levels were associated with significant fibrosis in patients with MASLD.