{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T19:23:44Z","timestamp":1793733824624,"version":"4.6.1"},"reference-count":18,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["13GW0649C"],"award-info":[{"award-number":["13GW0649C"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["BA 2092\/11\u20103"],"award-info":[{"award-number":["BA 2092\/11\u20103"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Current guidelines recommend FIB\u20104 and transient elastography for non\u2010invasive risk stratification in metabolic dysfunction\u2010associated steatotic liver disease (MASLD). These tests can predict the presence or absence of advanced fibrosis, but their accuracy for identifying significant fibrosis in MASLD patients eligible for novel drug treatments remains unclear. In a multicenter cohort of 458 biopsy\u2010proven MASLD patients, we evaluated the suitability of FIB\u20104 for identifying MASLD with histologically significant fibrosis (\u2265 F2). In a subcohort of 291 patients, we further assessed the diagnostic performance of the guideline\u2010based sequential use of FIB\u20104 and transient elastography. We demonstrate that the recommended risk stratification remains suboptimal for the identification of patients with significant fibrosis, resulting in remarkably high false\u2010positive and false\u2010negative rates for FIB\u20104 (43% and 26%, respectively). Consequently, guideline\u2010based risk stratification may misclassify a significant proportion of patients, leading to inappropriate treatment decisions regarding novel MASLD therapies approved for F2\/F3 fibrosis.<\/jats:p>","DOI":"10.1111\/liv.70281","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T06:14:59Z","timestamp":1754720099000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Limitations of Guideline\u2010Recommended Risk Stratification in Identifying\n                    <scp>MASLD<\/scp>\n                    Patients for Novel Drug Treatments"],"prefix":"10.1111","volume":"45","author":[{"given":"Martin","family":"Franck","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"John","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1219-4044","authenticated-orcid":false,"given":"Monika","family":"Rau","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Internal Medicine II University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Geier","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Internal Medicine II University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan\u2010Peter","family":"Sowa","sequence":"additional","affiliation":[{"name":"Department of Medicine Universit\u00e4tsklinikum Knappschaftskrankenhaus Bochum, Ruhr University Bochum  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-4703","authenticated-orcid":false,"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I University Medical Center Mainz  Mainz Germany"},{"name":"Department of Internal Medicine II Saarland University Medical Center  Homburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00fcnevver","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology, Campus Virchow Clinic and Campus Charit\u00e9 Mitte Charit\u00e9 University Medicine  Berlin Germany"},{"name":"Clinic for Gastroenterology and Hepatology University Hospital of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-0480","authenticated-orcid":false,"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1443-2720","authenticated-orcid":false,"given":"Klaus","family":"Schulze\u2010Osthoff","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine University of T\u00fcbingen  T\u00fcbingen Germany"},{"name":"German Cancer Consortium and German Cancer Research Center  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Bantel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.04.031"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000323"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29085"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.04.043"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000670"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.07.049"},{"issue":"9","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"e733","DOI":"10.1055\/a-1880-2388","article-title":"Updated S2k Clinical Practice Guideline on Non\u2010Alcoholic Fatty Liver Disease (NAFLD) Issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS)","volume":"60","author":"Tacke F.","year":"2022","journal-title":"Zeitschrift f\u00fcr 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FDA Approval of Rezdiffra (resmetirom) for the Treatment of Patients with Noncirrhotic Nonalcoholic Steatohepatitis (NASH) with Moderate to Advanced Liver Fibrosis."}],"container-title":["Liver 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