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However, in some patients, MASLD presents with cholestatic pattern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT\/ULN)]\/[(ALP\/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H),\u2009&gt;\u20095; (b) mixed pattern(M),2\u20135; (c) cholestatic pattern(C),\u2009&lt;\u20092. Outcomes: (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H\n                      <jats:italic>vs.<\/jats:italic>\n                      41.9% M\n                      <jats:italic>vs.<\/jats:italic>\n                      31.9% C) were more common in H-pattern (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001),whilst C-pattern was linked to cirrhosis (5.8% H\n                      <jats:italic>vs.<\/jats:italic>\n                      5.6% M\n                      <jats:italic>vs.<\/jats:italic>\n                      10.9% C;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001). FIB-4(0.74(95% CI 0.69\u20130.79)\n                      <jats:italic>vs.<\/jats:italic>\n                      0.83 (95% CI 0.80\u20130.85);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69\u20130.85)\n                      <jats:italic>vs.<\/jats:italic>\n                      0.84 (95% CI 0.80\u20130.87);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12\u20135.02);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00535-024-02098-8","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T09:01:56Z","timestamp":1713171716000},"page":"586-597","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The biochemical pattern defines MASLD phenotypes linked to distinct histology and 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