{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T09:45:35Z","timestamp":1793699135631,"version":"4.5.1"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["20OC0059393"],"award-info":[{"award-number":["20OC0059393"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["668031"],"award-info":[{"award-number":["668031"]}],"id":[{"id":"10.13039\/100010661","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":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non\u2010invasive tests (NITs) are central to diagnosing and stratifying risk in steatotic liver disease (SLD). However, it remains unclear whether guideline\u2010recommended NIT cut\u2010offs apply to metabolic and alcohol\u2010related liver disease (MetALD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Evaluate the diagnostic and prognostic performance of five NITs in patients with MetALD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single\u2010centre study with 423 SLD patients, of whom 102 (24%) had MetALD. Patients were classified using histological or controlled attenuation parameter\u2010defined hepatic steatosis and self\u2010reported alcohol intake. We assessed the circulating markers of FIB\u20104, LiverRisk score, ELF and ADAPT together with transient elastography (TE) using established cut\u2010offs for advanced fibrosis (\u2265\u2009F3). Liver histology served as reference. Prognostic performance for hepatic decompensation and all\u2010cause mortality was evaluated over a median follow\u2010up of 62\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among circulating NITs in MetALD, ELF and ADAPT both had the highest diagnostic accuracy (AUROC\u2009=\u20090.90), while it was lowest with LiverRisk score (AUROC\u2009=\u20090.74). The indeterminate zone between rule\u2010out and rule\u2010in cut\u2010offs was largest for FIB\u20104 (34%). TE and circulating NIT concordance was highest for LiverRisk score (81%) to rule\u2010out \u2265\u2009F3, and highest for ELF (88%) to rule\u2010in \u2265\u2009F3. All included NITs predicted decompensation\u2010free survival with their corresponding rule\u2010out or rule\u2010in cut\u2010offs. A sequential 2\u2010tier testing strategy (FIB\u20104\u2009\u2192\u2009TE) effectively stratified risk of decompensation. Incorporating a second\u2010tier test (ELF or ADAPT) before TE reduced the number of TE referrals by 43% and 45%, without loss of prognostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Widely available NITs are applicable for MetALD, where cut\u2010offs can be used to diagnose advanced fibrosis and predict clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70281","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T07:26:23Z","timestamp":1754897183000},"page":"990-1002","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["<scp>M<\/scp>\n                    et\n                    <scp>ALD<\/scp>\n                    : Diagnosis and Prognosis With Non\u2010Invasive Tests"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4378-6256","authenticated-orcid":false,"given":"Nikolaj","family":"Torp","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9443-5846","authenticated-orcid":false,"given":"Mads","family":"Israelsen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5031-2294","authenticated-orcid":false,"given":"Stine","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Semmler","sequence":"additional","affiliation":[{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Dalby Hansen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrine Tholstrup","family":"Bech","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette Lehmann","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Department of Gastroenterology and Hepatology Herlev Hospital  Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrine Holtz","family":"Thorhauge","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"},{"name":"Institute of Clinical Research University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle Lindholm","family":"Schnefeld","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centre for Liver Research Odense University Hospital  Odense 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