What is MASH?
Metabolic-dysfunction Associated Steatohepatitis (MASH) is the most severe form of Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD), a highly underdiagnosed cause of severe liver complications. MASLD is estimated to affect nearly 80 million people in the US, but only 5% are aware they have liver disease. Prior to 2024, MASLD and MASH were called Non-alcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatisis (NASH) respectively.
Diagnosis
MASH is a complex disease that requires doctors to know about three critical components of liver health: liver fat, liver fibrosis and liver inflammation. To get a good idea of each of these without liver biopsy, physicians can utilize a combination of MRI biomarkers and blood tests.
Together, these markers of disease activity can be very accurate for ruling-in "at-risk MASH" and assessing its severity - and most critically, the fibrosis stage. Fibrosis is measured by the MR Elastography (MRE), which was invented at Mayo Clinic. Severe liver fibrosis is the parameter of liver histology that is most associated to adverse liver outcomes (e.g., cirrhosis).
MASH Calculator
There are a number of new scoring systems to help diagnose "at-risk MASH" - namely those with MASH and ≥F2 fibrosis. You can use the calculator here to automatically calculate your patient's risk of MASH using two of these scoring systems: the MAST score and MEFIB score.
The MAST score uses MRE, MRI-PDFF and AST, and has been shown to have high accuracy in predicting adverse clinical outcomes in the next five years. The MEFIB score uses MRE and FIB-4 score to rule-in patients with MASH and ≥F2 fibrosis with a positive predictive value of ≥90%.
How to interpret MAST/MEFIB
low-risk of MASH with advanced fibrosis
indeterminate (if applicable)
high-risk of MASH with advanced fibrosis
Results
F0
F1
F2
F3
F4
MR Elastography (kPa)
MRI-PDFF (%)
FIB-4
AST (U/L)
(must include FIB-4)
Required Fields
MAST: MRE + PDFF + AST
MEFIB: MRE + FIB-4
How to Use This Calculator
Depending on score, the MAST score can be used to reliably predict (with high 80-low 90% accuracy) which patients are most likely to experience a liver-related event in the next five years.
The MEFIB score can reliably predict (90%+ accuracy) which patients currently are most likely to at-MASH with ≥F2 fibrosis, and who may be candidates for pharmacological treatment.
If Your Patient is at-Risk for NASH
If you suspect your patient has NASH with fibrosis, there are treatment options.
Most cases of NASH can be treated with life style changes (including diet and exercise regimens) and possibly prescription medicines.
www.coulditbeNASH.org is supported by Resoundant. Other NASH scoring systems may be used by clinicians. Calculations should be re-checked and should not be used alone to guide patient care, nor should they substitute for clinical judgment.
© 2024
This webpage encludes Clinical Decision Support Software and is exempt from regulation by the FDA under 21 U.S.C. 360j(o). By using this software, the user acknowledges and agrees that he or she is a health care professional experienced in diagnosing liver disease. The software only supports or provides recommendations to a health care professional, who must not rely primarily on any such recommendations to make a clinical diagnosis or treatment decision regarding an individual patient and who may independently review the basis for such recommendations. The user is solely responsible for any final decision regarding the condition of any individual patient. The user agrees to indemnify and hold harmless Resoundant from any costs, expenses, damages, or other liabilities resulting from any claims relating to use of the software.