Metabolic dysfunction-associated steatotic liver disease:non-invasive assessment of disease progression

This doctoral thesis, undertaken as part of a joint PhD program between the University of Medicine and Pharmacy "Iuliu Hațieganu," Cluj-Napoca, Romania, and Alma Mater Studiorum University of Bologna, Italy, focuses on metabolic dysfunction-associated steatotic liver disease (MASLD). With its increasing prevalence and potential progression to advanced fibrosis, cirrhosis, and hepatocellular carcinoma, the research explores non-invasive diagnostic techniques and therapeutic strategies aimed at improving disease management and patient outcomes. The study I validated vibration-controlled transient elastography (VCTE)-based scores—Agile 3+, Agile 4, and FAST—in Caucasian MASLD patients for the first time. Agile 3+ and Agile 4 demonstrated excellent diagnostic accuracy in identifying advanced fibrosis and cirrhosis, while the FAST score showed moderate performance in detecting fibrotic metabolic dysfunction-associated steatohepatitis (MASH). Within Study II, a multilevel random effects model meta-analysis established standardized cut-off values for two-dimensional shear wave elastography (2D-SWE) in staging liver fibrosis, supporting its broader clinical use. Study III examined the role of non-selective beta-blockers (NSBB) in preventing the first decompensation event in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH). NSBB significantly reduced the risk of first decompensation, even in patients with small varices and porto-systemic shunts. Notably, type 2 diabetes mellitus (T2DM) emerged as an independent predictor of decompensation, regardless of liver disease etiology. These findings contribute to the refinement of non-invasive fibrosis assessment in MASLD and highlight the therapeutic value of NSBB in cirrhosis management. By improving diagnostic precision and identifying key risk factors for disease progression, this research offers valuable insights for optimizing MASLD patient care and prognosis.