How is metabolic disease-associated steatosis with moderate (stage 2) fibrosis classified?

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Last updated: September 15, 2026 • View editorial policy

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Clasificación de Esteatosis con Fibrosis Moderada por Enfermedad Metabólica

La esteatosis con fibrosis moderada (estadio 2) por enfermedad metabólica se clasifica como Enfermedad Hepática Esteatósica Asociada a Disfunción Metabólica (MASLD, por sus siglas en inglés), específicamente como esteatohepatitis asociada a disfunción metabólica (MASH) con fibrosis significativa estadio F2. 1, 2

Marco de Clasificación Actual

Según las guías clínicas EASL-EASD-EASO 2024, el espectro de MASLD incluye 1:

  • Esteatosis aislada (MASL - metabolic dysfunction-associated steatotic liver)
  • Esteatohepatitis (MASH - metabolic dysfunction-associated steatohepatitis)
  • Fibrosis (estadios F0-F4)
  • Cirrosis
  • Carcinoma hepatocelular relacionado con MASH

Criterios Diagnósticos Específicos

Para clasificar su caso como MASLD, debe cumplir 1, 2:

  1. Presencia de esteatosis hepática (por imagen o biopsia)

  2. Al menos un factor de riesgo cardiometabólico:

    • Diabetes tipo 2
    • Obesidad
    • Hipertensión arterial
    • Dislipidemia
    • Circunferencia abdominal aumentada

  3. Ausencia de consumo dañino de alcohol:

    • <20 g/día en mujeres
    • <30 g/día en hombres

Importancia Clínica de la Fibrosis Moderada (F2)

La fibrosis estadio ≥2 se considera "fibrosis significativa" y representa un punto de corte crítico para decisiones terapéuticas. 1, 2

Las guías 2024 establecen que pacientes con MASH no cirrótica y fibrosis significativa (estadio ≥2) deben considerarse para tratamiento dirigido con resmetirom, el primer fármaco aprobado que demostró efectividad histológica en esteatohepatitis y fibrosis 1, 2.

Evaluación No Invasiva Recomendada

Para estratificación de riesgo, se recomienda un enfoque escalonado 1, 2:

Paso 1: Índice FIB-4 (prueba sanguínea inicial)

Paso 2: Si FIB-4 es indeterminado o elevado → Elastografía de transición

Paso 3: Biopsia hepática cuando:

  • Hay discrepancia entre pruebas no invasivas
  • Se necesita confirmar MASH en riesgo
  • Se debe diferenciar de otras hepatopatías crónicas 3

Implicaciones Pronósticas

La fibrosis avanzada es el principal determinante de morbimortalidad relacionada con el hígado en MASLD 3. Los pacientes con fibrosis F2 tienen:

  • Mayor riesgo de progresión a cirrosis
  • Riesgo aumentado de eventos cardiovasculares
  • Necesidad de vigilancia para hipertensión portal y carcinoma hepatocelular
  • Indicación para tratamiento farmacológico específico si está disponible localmente 1

Caveat Importante

No confundir con la antigua nomenclatura: MASLD reemplaza el término "enfermedad del hígado graso no alcohólico" (NAFLD), y MASH reemplaza "esteatohepatitis no alcohólica" (NASH). Esta actualización de nomenclatura ocurrió en 2023-2024 1, 2, 4.

References

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