{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:54:49Z","timestamp":1791482089693,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"11-12","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004853","name":"Chinese University of Hong Kong","doi-asserted-by":"publisher","award":["Direct Grant (2022.031)"],"award-info":[{"award-number":["Direct Grant (2022.031)"]}],"id":[{"id":"10.13039\/501100004853","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Early screening may prevent fibrosis progression in metabolic\u2010associated fatty liver disease (MAFLD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We developed and validated MAFLD fibrosis score (MFS) for identifying advanced fibrosis (\u2265F3) among MAFLD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross\u2010sectional, multicentre study consecutively recruited MAFLD patients receiving tertiary care (Malaysia as training cohort [<jats:italic>n<\/jats:italic>\u2009=\u2009276] and Hong Kong and Wenzhou as validation cohort [<jats:italic>n<\/jats:italic>\u2009=\u2009431]). Patients completed liver biopsy, vibration\u2010controlled transient elastography (VCTE), and clinical and laboratory assessment within 1\u2009week. We used machine learning to select \u2018highly important\u2019 predictors of advanced fibrosis, followed by backward stepwise regression to construct MFS formula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MFS was composed of seven variables: age, body mass index, international normalised ratio, aspartate aminotransferase, gamma\u2010glutamyl transpeptidase, platelet count, and history of type 2 diabetes. MFS demonstrated an area under the receiver\u2010operating characteristic curve of 0.848 [95% CI 0.800\u2013898] and 0.823 [0.760\u20130.886] in training and validation cohorts, significantly higher than aminotransferase\u2010to\u2010platelet ratio index (0.684 [0.603\u20130.765], 0.663 [0.588\u20130.738]), Fibrosis\u20104 index (0.793 [0.735\u20130.854], 0.737 [0.660\u20130.814]), and non\u2010alcoholic fatty liver disease fibrosis score (0.785 [0.731\u20130.844], 0.750 [0.674\u20130.827]) (DeLong's test <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). MFS could include 92.3% of patients using dual cut\u2010offs of 14 and 15, with a correct prediction rate of 90.4%, resulting in a larger number of patients with correct diagnosis compared to other scores. A two\u2010step MFS\u2010VCTE screening algorithm demonstrated positive and negative predictive values and overall diagnostic accuracy of 93.4%, 89.5%, and 93.2%, respectively, with only 4.0% of patients classified into grey zone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MFS outperforms conventional non\u2010invasive scores in predicting advanced fibrosis, contributing to screening in MAFLD patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17722","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T10:44:48Z","timestamp":1695120288000},"page":"1194-1204","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["<scp>MAFLD<\/scp> fibrosis score: Using routine measures to identify advanced fibrosis in metabolic\u2010associated fatty liver disease"],"prefix":"10.1111","volume":"58","author":[{"given":"Johnny T. K.","family":"Cheung","sequence":"first","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinrong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-9389","authenticated-orcid":false,"given":"Grace Lai\u2010Hung","family":"Wong","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1819-2464","authenticated-orcid":false,"given":"Terry Cheuk\u2010Fung","family":"Yip","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huapeng","family":"Lin","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanlin","family":"Li","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard Ho\u2010Wai","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Anatomical and Cellular Pathology The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy Che\u2010To","family":"Lai","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5824-0590","authenticated-orcid":false,"given":"Sanjiv","family":"Mahadeva","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Raihan","family":"Nik\u00a0Mustapha","sequence":"additional","affiliation":[{"name":"Department of Pathology Hospital Sultanah Bahiyah  Alor Setar Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Dong","family":"Wang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen\u2010Yue","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology the First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2215-9410","authenticated-orcid":false,"given":"Vincent Wai\u2010Sun","family":"Wong","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Centre, Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong China"},{"name":"State Key Laboratory of Digestive Disease, Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9105-5837","authenticated-orcid":false,"given":"Wah\u2010Kheong","family":"Chan","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University of Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-2631","authenticated-orcid":false,"given":"Ming\u2010Hua","family":"Zheng","sequence":"additional","affiliation":[{"name":"Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province  Wenzhou China"},{"name":"MAFLD Research Centre, Department of Hepatology the First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28431"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14638"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(20)32511\u20103"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2019.0001n"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28785"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20701"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50346"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21496"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.02.031"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101746.2011.06774.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.1999.01377.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102018\u2010317334"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i11"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.07.049"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.10.034"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102021\u2010324243"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2019.00877"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.06.021"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v5.i5.281"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876\u2010021\u201001790\u2010w"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102015\u2010309260"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.11.004"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29367"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010020\u201010094\u20102"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.740"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800680"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T19:13:12Z","timestamp":1700680392000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.17722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,19]]},"references-count":27,"journal-issue":{"issue":"11-12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1111\/apt.17722"],"URL":"https:\/\/doi.org\/10.1111\/apt.17722","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,19]]},"assertion":[{"value":"2023-07-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}