Simple Score Research Articles

Estimating power in complex nonlinear structural equation modeling including moderation effects: The powerNLSEM R-package

The model-implied simulation-based power estimation (MSPE) approach is a new general method for power estimation (Irmer et al., 2024). MSPE was developed especially for power estimation of non-linear structural equation models (SEM), but it also can be applied to linear SEM and manifest models using the R package powerNLSEM. After first providing some information about MSPE and the new adaptive algorithm that automatically selects sample sizes for the best prediction of power using simulation, a tutorial on how to conduct the MSPE for quadratic and interaction SEM (QISEM) using the powerNLSEM package is provided. Power estimation is demonstrated for four methods, latent moderated structural equations (LMS), the unconstrained product indicator (UPI), a simple factor score regression (FSR), and a scale regression (SR) approach to QISEM. In two simulation studies, we highlight the performance of the MSPE for all four methods applied to two QISEM with varying complexity and reliability. Further, we justify the settings of the newly developed adaptive search algorithm via performance evaluations using simulation. Overall, the MSPE using the adaptive approach performs well in terms of bias and Type I error rates.

Histologic healing and clinical outcomes in ulcerative colitis.

Growing evidence suggests histologic healing (HH) improves clinical outcomes in ulcerative colitis (UC) patients beyond endoscopic healing (EH). We hypothesize that HH is associated with better clinical outcomes in Asian UC patients, for whom data is lacking. We performed a retrospective study of UC patients in clinical remission (CR) with a follow-up colonoscopy and minimum 1-year follow-up post-colonoscopy. Primary outcome was clinical relapse (CRL), defined as either a Simple Clinical Colitis Activity Index score of > 2, medication escalation, hospitalization or colectomy. Predictors of CRL and HH were assessed. One hundred patients were included with a median follow-up of 22 months. At index colonoscopy, 80 patients were in EH. On follow-up, 41 patients experienced CRL. Of 80 patients in EH, 34 (42.5%) had persistent histologic activity (Nancy Index ≥ 2) and 29 (36.3%) relapsed during the follow-up period. Amongst patients in CR and EH, those with HH had lower CRL rate (26.1% vs. 50.0%, P= 0.028) and longer CRL-free survival (mean 46.1 months vs. 31.5 months, P= 0.015) than those with persistent histologic activity. On bivariable analysis of 100 patients in CR, HH, and Mayo endoscopic score (MES) of 0 were significantly associated with lower risk of CRL. On multivariable analysis, only MES 0 remained predictive of lower CRL risk. Above and beyond CR and EH, achieving HH improves clinical outcomes in Asian UC patients. However, HH may not confer incremental benefit if MES 0 has been achieved. Further prospective studies evaluating the benefit of histologically guided therapeutic decisions are needed.

Peak enhancement in contrast-enhanced ultrasound for assessing endoscopic disease activity in patients with Crohn's disease: a meta-analysis.

Contrast-enhanced ultrasound (CEUS) has been proposed as a valuable tool for detecting disease activity in patients with Crohn's disease (CD). However, previous studies have utilized different parameters, leading to variation in clinical assessment of this technique. To assess the effectiveness of peak enhancement (PE) in CEUS for evaluating endoscopic disease activity in patients with CD. Articles were obtained by searching PubMed, Embase, Web of Science, Wanfang, and CNKI databases. Only studies that investigated the effectiveness of PE in CEUS to discriminate endoscopic disease activity in patients with CD were considered. Pooled sensitivity and specificity were then calculated using a random effects model. Overall, seven studies were included. The endoscopic disease activity of CD was determined based on the simple endoscopic score for Crohn's disease and Crohn's Disease Endoscopic Index of Severity scores. Pooled results showed that a high PE was associated with increased detection efficacy for endoscopic disease activity in CD. Pooled sensitivity, specificity, and positive and negative likelihood ratios were 0.88 (95% confidence interval [CI] = 0.71-0.96), 0.88 (95% CI = 0.81-0.93), 7.60 (95% CI = 4.61-12.53), and 0.14 (95% CI = 0.05-0.35), respectively. The pooled receiver operating characteristic was 0.90 (95% CI = 0.87-0.92), suggesting a good discriminating efficacy of PE in CEUS for endoscopic disease activity of patients with CD. A high PE in CEUS displayed substantial distinguishing accuracy for assessing endoscopic disease activity of patients with CD.

A Simple Score Scale Composed of Serum Inflammatory Factors Assists in Psoriasis Arthritis Prediction among Patients with Psoriasis Vulgaris.

Aim: To compare the levels of serum inflammatory indicators in psoriasis vulgaris patients who progress to PsA and those not, as well as to establish and validate a simple score scale for predicting PsA for psoriasis vulgaris patients. Methods: A cross-sectional study was performed at a university hospital in China to recruit five hundred and seventy-seven patients who had been diagnosed with psoriasis vulgaris for at least 10 years. After evaluation, 86 were enrolled in the PsA group, and the others were selected as the control group. Eight serum inflammatory factors were detected and compared between the two groups. A simple score scale for PsA prediction was established and validated. Results: Serum CRP, IL-6, and TNF-α levels were significantly higher in the PsA group than in the control group. A simple score scale composed of CRP, IL-6, and TNF-α was established. The sensitivity was 59.30% and the specificity was 83.50% for predicting PsA among all psoriasis vulgaris patients when the cut-off value of the total score was set as 1.8 points. The simple score scale presented a predictive value for progressing to PsA among all psoriasis vulgaris patients internally (AUC = 0.788), and the performance was also conformed in psoriasis vulgaris patients receiving topical treatment (AUC = 0.746), systemic treatment (AUC = 0.747) and biological treatment (AUC = 0.808), respectively. The predictive performance of this scale was also validated by an external retrospective cohort (AUC = 0.686). Conclusions: CRP, IL-6, and TNF-α were potential indicators to recognize PsA risk in patients with psoriasis vulgaris. A simple score scale may provide new insights for early prediction of PsA among psoriasis vulgaris patients.

An Investigation of Parturient Ocular Appearance in Sows.

Protocols that enable prompt identification of sows in need of assistance during farrowing are important for optimal production outcomes. Change in the colour and appearance of the sclera of the eye can indicate increased stress. This warrants investigation into its use for the identification of sows in need of assistance at the time of parturition. To this end, a three-level ocular scoring system for the pig was devised and subsequently used in a preliminary investigation into the relationship between farrowing kinetics and visual changes in the sclera at farrowing. Data were collected and analysed from twenty randomly selected Large White × Landrace crossbred sows during farrowing. It was determined that sows with a severe ocular score were more likely to experience a prolonged farrowing duration (p = 0.013) and incur increased parturient straining of either total straining time (p = 0.011) or straining per piglet (p = 0.025). There was a significant association between ocular score and litter size (p = 0.043). Ocular score was not associated with sow parity (p = 0.728) and inter-piglet interval (p = 0.075). The proposed three-level scoring system successfully identified sows experiencing an abnormal parturition as defined by a prolonged farrowing duration and increased straining time. Findings from this study suggest the potential application of this simple ocular scoring tool for identifying sows experiencing an abnormal farrowing via in-person application or integration into remote monitoring systems in the future.

Severity Scores for Cutaneous Lupus Erythematosus

Despite the significant disease burden of cutaneous lupus erythematosus (CLE), there have been no United States Food and Drug Administration-approved therapies for 65 years. To facilitate advancement of therapies, severity scores are needed to evaluate QOL, how patients feel, activity of disease, and organ-specific damage to assess response to therapies and disease progression. In this paper, we delineate the development process of provider- and patient-reported severity scores for CLE. Cutaneous Lupus Disease Area and Severity Index (CLASI), a provider-reported measure that distinguishes between activity and damage, has undergone rigorous validation and reliability testing for over 20 years. Its performance has been tested in clinical trials as a primary or secondary endpoint and tool to stratify patients. As an objective disease measure that captures a provider's perspective of disease activity and damage, the CLASI inherently does not assess disease impact on patients' QOL. Cutaneous Lupus Erythematosus Quality of Life (CLEQoL), a patient-reported measure, captures features elucidated through focus groups, including symptoms, emotions, functioning, body image, and photosensitivity. It has undergone psychometric property testing to ensure reliability and validity. Together, CLASI and CLEQoL are simple and reliable CLE-specific severity scores capturing disease activity, damage, and QOL from provider and patient perspectives.

Predicting the risk of nursing home placement of elderly persons using a population-based stratification score

ObjectiveTo develop and validate a novel score predictive of nursing home placement in elderly. Study designPopulation-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy. MethodsThe 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration. ResultsTwenty-one factors were identified as predictive of nursing home admission and were included in the “Elderly Nursing Home Placement” (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk. ConclusionsA simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.

WP4.4 - Is it appendicitis? Keeping it SIMPLE

Abstract Aims Several appendicitis scoring systems have been described, criteria used for these are subjective leading to interobserver-bias. Existence of many scores instead of one suggests most of them are not clinically useful. We describe a SIMPLE score that is based on objective parameters as listed in Table 1. Methods A sample size for prospective evaluation was performed based on analysis of 118 patients of all ages with suspected appendicitis assessed at a University Hospital (area under ROC-curve of 0.7, null AUC 0.5, alpha 0.05, power 0.95). Each variable point weightage was calculated using multivariate analysis. ROC-analysis was used to define cut-offs for Leukocytes and CRP (GraphPad Prism-V9) as listed in Table -1. A SIMPLE-score was devised and prospectively validated. Results Table-1 SIMPLE-score Variable Odds ratio (95% CI) P-value Points Shift of abdominal pain 3.8 (1.3 – 12.1) 0.02 1 Impaired Oral intake 6.0 (1.5 – 31.5) 0.02 2 Mid-cycle 0.3 (0.0 – 2.1) 0.27 -1 Pyrexia of ≥37.5°C 2.5 (1.0 – 6.1) 0.04 1 Leukocytosis ≥10 5.5 (2.1 – 16.1) 0.00 2 Elevated CRP ≥9 4.0 (1.5 – 11.2) 0.01 2 SIMPLE score was calculated prospectively for 128 patients. Median age was 26.5 (range 4-85 years). Of these 62.5% (80) were females 37.5% (48) were males. A SIMPLE score of 2 or less was unlikely to be appendicitis (93.5% Negative Predictive Value), while a score of 3-6 was possibly appendicitis and a score of 7 or more was strongly associated with appendicitis (85% Positive Predictive Value). Conclusions SIMPLE score is objective, reliable, reproducible and indeed SIMPLE to use.

Prognosis, risk factors, and scoring model of patients resuscitated from traumatic cardiac arrest: A multicenter observational study in Japan.

A subset of patients with traumatic cardiac arrest is salvageable when the reversible causes of cardiac arrest are promptly treated. However, prognosis and risk factors of survivors upon hospital admission after traumatic cardiac arrest remain unclear. We aimed to describe the outcomes, identify risk factors, and develop a simple risk-scoring model for patients resuscitated from traumatic cardiac arrest. This observational multicenter study analyzed data from the Japan Trauma Data Bank from January 1, 2019, to December 31, 2021. Patients who underwent cardiopulmonary resuscitation in the emergency department and survived to the day after hospital admission for traumatic cardiac arrest were included. Factors associated with survival to hospital discharge were determined using mixed-effects multivariable logistic regression analysis. A simple scoring model was developed to stratify the probability of survival to hospital discharge. In total, 452 patients from 119 hospitals (median age, 64 years; 334 [74.4%] men) were included in the analysis. Of these, 130 (28.8%) survived until discharge. Penetrating injury, signs of life upon hospital arrival, and Injury Severity Score were significantly associated with survival at hospital discharge. A scoring model that assigned 1 point each for penetrating injury and signs of life upon hospital arrival effectively stratified the probability of survival to hospital discharge, with scores of 0, 1, and 2 corresponding to survival probabilities of 12.2%, 35.2%, and 83.3%, respectively. This study described the outcomes and risk factors of patients resuscitated from traumatic cardiac arrest. Our simple scoring model effectively stratified the likelihood of survival to hospital discharge. Therapeutic/Care Management; Level III.

Acupuncture for chronic nonspecific low back pain in middle-aged and older patients: A randomized controlled trial: 针刺治疗中老年慢性非特异性下腰痛:一项随机对照临床试验

ObjectiveTo observe the specific effects of acupuncture in middle-aged and older patients with chronic nonspecific low back pain (CNSLBP). MethodsSixty-six patients with CNSLBP were randomized into the acupuncture or sham acupuncture groups (n = 33). In the acupuncture group, penetrating acupuncture with a long needle was delivered at Ashi points (painful/sensitive points), and the needles were manipulated by rotating technique after deqi till patients felt distending pain. The needles were retained in place for 30 min. Acupuncture was given three times per week for 4 weeks. In the sham acupuncture group, shallow needling was performed at non-meridian, non-acupoint, non-painful, and non-sensitive points. The needle retention and duration of treatment were the same as those of the acupuncture group before treatment, after the first intervention, after the whole treatment, and in follow-up visit (4 weeks after the whole treatment). The scores of the visual analog scale(VAS) for pain, range of movement (ROM) of the spine, and simplified Oswestry Dysfunction Index (ODI) were observed separately. ResultsCompared to the outcomes before treatment, the VAS score, spinal ROM, and simplified ODI score were lower after the first intervention, after treatment, and in follow-up visits in the acupuncture group, indicating the statistical significance (P < 0.05). When compared with the sham acupuncture group, the VAS score, spinal ROM, and simplified ODI score were significantly lower in the acupuncture group after the first intervention, after treatment, and in follow-up visit (P < 0.05). The total effective rate was 90.9% in the acupuncture group, which was significantly higher than that (75.76 %) in the sham acupuncture group (P < 0.05). ConclusionAcupuncture has a specific effect on CNSLBP in middle-aged and older patients and a superior effect on immediate analgesia.

Development and validation of a prognostic scoring system for 1-year mortality in older patients with hip fractures.

Hip fractures in older people result in increased mortality. We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. Retrospective study. Multicenter. Patients aged ≥65years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients.

548P Simplified immune score based on CD8+ T-cells at the invasive margin provides comparable prognostic value to immune scores in non-metastatic colorectal cancer

548P Simplified immune score based on CD8+ T-cells at the invasive margin provides comparable prognostic value to immune scores in non-metastatic colorectal cancer

Validation of thoracolumbar injury classification and Severity Score in the management of acute and subacute Osteoporotic vertebral compression fractures – A pilot study and a suggested modification

ObjectiveTo retrospectively assess the Thoracolumbar Injury Classification and Severity Score (TLICS) in patients with osteoporotic vertebral compression fractures (OVCF) and compare the treatment given with that predicted by the TLICS score. MethodsAll medical records of patients presenting from January 2014 to November 2017 for acute atraumatic or low impact OVCF were screened, and eligible patients were retrospectively reviewed. The TLICS score was determined based upon magnetic resonance imaging (MRI) findings and clinical records. Clinical records (including pain score data), imaging data, operative procedures, and stability of neurological examination were tracked over three months for each patient. ResultsOf the 56 patients included, 36 patients had a TLICS score of 1, 18 had a TLICS score of 2, and two had a TLICS score of 4. Only one patient with a TLICS score of 4 underwent surgical stabilization, while the rest of the cohort was managed non-operatively, with or without kyphoplasty. TLICS score 1 corresponded to simple compression and TLICS score 2 corresponded to burst morphology with retropulsion and without neurological deficits. Of the patients with a TLICS score of 1 and 2 who underwent kyphoplasty, there was a statistically significant improvement in pain scores in both groups; however no significant difference was observed, between each TLICS score (i.e., 1 or 2). None of the patients developed instability or neurological decline. ConclusionTLICS score correctly predicted operative versus non-operative management in all patients with OVCF. TLICS may be used in making management decisions, and in the triage of these patients for operative versus non-operative evaluations. Our study suggests that patients with TLICS score of 4 or higher require surgical evaluation, while those with TLICS of 1 or 2 are likely to have satisfactory non-surgical management with augmentation or conservative care. In general, patients with OVCF typically present with low TLICS score. Kyphoplasty appears to be similarly beneficial in patients with a TLICS score of 1 or a TLICS score of 2. A modification of the TLICS score by adding TLICS Zero to include uncompressed OVCF with edema is suggested. The limitations of this study include a small size; a larger study is needed to confirm these findings.

Nurturing Entrepreneurial Leadership: An Empirical Study of Elite Schools in Pakistan

The main purpose of the current research was to find out the students’ perspectives about the various qualities of entrepreneurial leadership developed in the students of Elite schools. The study adopted a descriptive research design. The research population was to be comprised of all students of higher secondary classes studying in grade 11 and grade12 in Elite schools of South Punjab of Pakistan. 400 students of higher secondary section of the sampled schools were selected by using simple random sampling technique. Quantitative data was collected through five-point Likert scale. The collected data was analyzed by using SPSS version 21.0. The simple percentages mean score, independent t-test, and P –values were calculated. Qualitative data obtained from open ended questions was analyzed through thematic approach. The findings revealed that the learning environment of the Elite schools is a contributory factor in developing Entrepreneurial Leadership among the students. Majority of the students are satisfied with the Entrepreneurial Leadership skills developed by these schools. The same model can be applied to other public sector educational institutions of Pakistan.

The Relationship Between Anxiety, Depression and Cognitive Functioning in Older Adults: An Exploratory Cross‐Sectional Analysis of Wave 1 Lothian Birth Cohort 1936 Data

ABSTRACTObjectivesTo explore the strength of the association between cognitive functioning and depression and anxiety in older people without dementia.MethodsAn exploratory, cross‐sectional analysis of Wave 1 (2004–2007) data from the Lothian Birth Cohort 1936 dataset. Three subgroups were based on Hospital Anxiety and Depression Scale (HADS) subscales: no probable anxiety or depression (N = 592), probable anxiety no depression (N = 122), probable depression with/without anxiety (depression) (N = 30). Regression analyses determined relationships between subgroups and identified cognitive test variables.ResultsParticipants were 744 individuals (male = 385 [51.5%]; mean [M] age = 69.5 years [Standard deviation = 0.83]); characteristics for subgroups were similar. Participants with probable depression had slower simple reaction time scores than those with no anxiety or depression (regression slope [β] on the log10 scale = 0.05, 95% Confidence Interval [0.03, 0.08], p ≤ 0.001). Those with probable anxiety had significantly worse scores on other tests: Spatial span (β = −0.80 [−1.36, −0.25], p ≤ 0.005), Symbol Search (β = −1.67 [−2.90, −0.45], p ≤ 0.01), Matrix Reasoning (β = −1.58 [−2.55, −0.60], p ≤ 0.005) and Block Design (β = −3.33 [−5.29, −1.37], p ≤ 0.001), than those without probable anxiety or depression.ConclusionProbable depression and anxiety were found to be associated with lower cognitive function in those without evidence of dementia. People with probable anxiety showed poorer performance in tests that concerned making decisions. People with probable depression showed slower processing speed.

Predictive Factors and Scoring System for Delayed Symptomatic Hyponatremia Following Endoscopic Endonasal Surgery: A Single-Center Retrospective Study

BackgroundsDelayed symptomatic hyponatremia (DSH) is one of the common complications following endoscopic endonasal surgery (EES). Currently, published studies have predominantly focused on delayed postoperative hyponatremia, while there is relatively limited research on DSH. MethodsWe analyzed 175 consecutive cases from a single center between 2019 and 2023, involving patients who underwent endoscopic endonasal surgery (EES) for pituitary adenoma or Rathke's cleft cyst (RCC), all histopathologically confirmed. We collected preoperative, intraoperative, and postoperative data, and performed statistical analysis to determine the incidence of postoperative diabetes insipidus (DI) and identify significant predictive factors. Based on these factors, we developed a simplified scoring system. ResultsThere were 29 cases (16.6%) of DSH occurrence. In the binary logistic regression analysis, Knosp grade ≥3 (OR, 4.19; 95% CI, 1.26-13.92; P=0.019), intraoperative cerebrospinal fluid leaks (OR, 3.93; 95% CI, 1.49-10.34; P=0.006), serum sodium on the second day after surgery (OR, 0.88; 95% CI, 0.78-1.00; P=0.049), and postoperative diabetes insipidus (OR, 2.88; 95% CI, 1.10-7.53; P=0.031) were factors with independent predictive value for DSH. The scoring system achieved a maximum area under the ROC curve (AUC) of 0.789 (95% CI, 0.697-0.881), with a cutoff value of 1, sensitivity of 86.2%, and specificity of 59.6%. ConclusionThe incidence rate of DSH after EES in patients was 16.8%. Knosp grade ≥3, intraoperative cerebrospinal fluid leaks, serum sodium concentration on the second day after surgery, and postoperative diabetes insipidus were associated with the occurrence of DSH.

Association between postprocedural echocardiographic and laboratory data and clinical outcomes in patients with preserved ejection fraction after catheter ablation for atrial fibrillation

BackgroundThe HFA-PEFF score comprising echocardiographic and laboratory data is designed to diagnose heart failure with preserved ejection fraction and holds prognostic value in patients who underwent catheter ablation for atrial fibrillation (AF). However, the incorporation of many variables into this score limits its practical use. ObjectiveWe aimed to develop and to validate a simplified score (AF-HFA-PEFF score) focusing on AF-related parameters to predict cardiovascular events and AF recurrence. MethodsWe retrospectively enrolled 354 patients with preserved ejection fraction who underwent AF ablation. Using Cox regression hazard ratios from the HFA-PEFF score variables, we generated a risk score from a random 50% of patients and validated it with the other half. ResultsUnivariate analysis revealed that postprocedural E/e′, tricuspid regurgitation peak gradient, left atrial volume index, and brain natriuretic peptide levels were associated with 3-year cardiovascular events or AF recurrence. We developed the AF-HFA-PEFF score incorporating these factors. In the derivation group, C statistics for cardiovascular events were 0.72 for the AF-HFA-PEFF score and 0.74 for the original HFA-PEFF score and 0.71 and 0.69 for AF recurrence, respectively. Validation demonstrated that patients with an AF-HFA-PEFF score <4 had a 3-year cardiovascular event risk of 1.4% vs 9.4% for scores ≥4 (P < .001). For AF recurrence, these figures were 9.7% and 65.6%, respectively (P < .001). ConclusionThe AF-HFA-PEFF score is simpler than the HFA-PEFF score and is equally associated with 3-year cardiovascular events and AF recurrence.

448.8: A simple scoring system during normothermic machine perfusion may salvage kidneys initially declined for transplantation.

448.8: A simple scoring system during normothermic machine perfusion may salvage kidneys initially declined for transplantation.

206.1: Seth-huddle for organ donation (S-HOD) score: A simple scoring system for assessment of hospitals for conversion of potential donors to actual donors.

206.1: Seth-huddle for organ donation (S-HOD) score: A simple scoring system for assessment of hospitals for conversion of potential donors to actual donors.

Noninvasive tools for the assessment of fibrosis in metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously nonalcoholic fatty liver disease (NAFLD), is the number one chronic liver disorder worldwide. Progression to advanced fibrosis marks the emergence of a significant risk of liver-related negative outcomes. However, only a minority of patients will present at this stage. Since widespread liver biopsy in unfeasible at such high disease prevalence, there was a need to develop noninvasive tests (NITs) that could easily and reliably be applied to patients with MASLD, regardless of clinical setting. The NITs include simple scores, like the fibrosis-4 (FIB-4) Index, patented serum tests, like the Enhanced Liver Fibrosis test (ELF™), and imaging-based modalities, like the vibration-controlled transient elastography (VCTE). Guidelines suggests a stepwise approach that utilizes more than one NIT, with FIB-4 <1.30 being used as a first step to rule out patients that do not need further testing. Subsequent choice of NIT will be influenced by setting, cost, and local availability. While these NITs are accurate, they are not perfect. As such, research is ongoing. A promising avenue is that of omics, a group of technologies that provide concomitant results on a large number of molecules (and other variables). With the advance of artificial intelligence, new NITs may arise from large demographic, biochemical, and radiological data sets.