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MASLD AI 03:58 AM
September 2025
Maly Tiev, NP, reviews two real-world cases to explain the critical differences between F3 advanced fibrosis and F4 cirrhosis in patients with MASLD/MASH, and how accurate staging changes treatment, prognosis, and surveillance strategies. Using non-invasive tests (NITs) such as FIB-4, FibroScan/Liver Stiffness (kPa), CAP, and the ELF test, she demonstrates how concordant results can guide management without biopsy, when discordant results may require further imaging or histology, and why platelet count and bilirubin trends are key for identifying cirrhosis. For patients with F3, Maly highlights the importance of lifestyle modification with 7–10% weight loss, diet and exercise counseling, optimization of type 2 diabetes and lipid control, potential use of GLP-1 therapy, and when resmetirom (FDA-approved for MASH with F2–F3 fibrosis) may be considered, along with repeat NITs for monitoring. For patients with F4, management shifts to cirrhosis care, including twice-yearly HCC surveillance (ultrasound ± AFP), variceal screening guided by liver stiffness and platelet thresholds, and strict emphasis on alcohol avoidance and cardiometabolic risk reduction, noting that resmetirom is not used in cirrhotic patients. This case-based discussion provides clinicians, APPs, and hepatology teams with practical tools to approach staging, risk stratification, and surveillance in MASLD/MASH.
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