Fig. 1. A simple and clear assessment and referral pathway is essential in streamlining the management of patients with metabolic dysfunction-associated steatotic liver disease, and this depends on available resources and local practice in terms of the defined role between primary and specialist care providers.
11,92 *For patients ≥ 65 years old, fibrosis-4 index cut-off 2.0 (instead of 1.3) may be used to improve specificity
34;
†Sensitivity and negative predictive value > 90%;
‡Patients should be considered for referral to specialist care if they have persistently elevated serum aminotransferase level and/or if the cause of elevated serum aminotransferase level is uncertain;
§Specificity and positive predictive value > 90%. cACLD, compensated advanced chronic liver disease; CSPH, clinically significant portal hypertension; HCC, hepatocellular carcinoma.
