NASH-CHECK patient-reported outcome instrument: evaluation of content and face validity for patients with metabolic dysfunction–associated steatohepatitis and compensated cirrhosis

TL;DR

NASH-CHECK is a questionnaire that was found to be suitable for patients with MASH who have early-stage liver scarring, helping to assess their symptoms and quality of life.

Contribution

The study confirms the suitability of NASH-CHECK for patients with compensated cirrhotic MASH, extending its use beyond non-cirrhotic cases.

Findings

Key symptoms and HRQOL impacts reported by patients with compensated cirrhotic MASH are already included in NASH-CHECK.

Cognitive debriefing confirmed that NASH-CHECK is considered important, relevant, and comprehensive by patients with compensated cirrhotic MASH.

No additional symptoms or HRQOL impacts were deemed relevant for inclusion in NASH-CHECK.

Abstract

NASH-CHECK is a patient-reported outcome measure (PROM) that assesses symptoms and broader health-related quality of life (HRQOL) impacts of metabolic dysfunction–associated steatohepatitis (MASH), previously called non-alcoholic steatohepatitis (NASH). The measure was initially developed and validated for patients with non-cirrhotic MASH. This study describes an evaluation of the suitability of NASH-CHECK for patients with compensated cirrhotic MASH.

Concept elicitation (CE) interviews were conducted with patients with clinically confirmed compensated cirrhotic MASH in the United States (US) and United Kingdom (UK) to determine the symptom burden and broader HRQOL impact of MASH. Symptoms and broader HRQOL impacts identified during analysis of the CE data were compared with the key concepts included in NASH-CHECK; any symptoms reported in the CE interviews but not reflected in NASH-CHECK were reviewed for relevance by clinical experts. The content validity of NASH-CHECK was evaluated further via cognitive debriefing (CD) interviews conducted with patients with compensated cirrhotic MASH in the US and UK.

CE interviews were conducted with 33 patients with compensated cirrhotic MASH (US = 9, UK = 24; 60.6% female; mean age, 64.3 years). Key symptoms described were similar to those reported by patients with non-cirrhotic MASH identified during the development of NASH-CHECK; these included abdominal pain, abdominal bloating, itch, fatigue, sleeping difficulties, and cognitive symptoms. Other key HRQOL impacts included activity limitations and emotional, social, relationship, and work impacts. All key symptom and broader HRQOL impacts reported by patients with compensated cirrhotic MASH are currently included in NASH-CHECK, and no additional symptoms or HRQOL impacts reported during the CE interviews were deemed relevant for inclusion. CD interviews were conducted with 17 patients with compensated cirrhotic MASH (US = 8, UK = 9; 47.1% female; mean age, 62.8 years). Patient feedback on NASH-CHECK content confirmed that the concepts captured by the items were considered important, relevant, and comprehensive for addressing the impact of compensated cirrhotic MASH.

The results support the content validity of NASH-CHECK for patients with compensated cirrhotic MASH, demonstrating that NASH-CHECK is a suitable PROM for use in clinical trials, studies, and practice for this patient population.

The online version contains supplementary material available at 10.1186/s41687-025-00881-6.

The condition widely known as non-alcoholic steatohepatitis (NASH) has recently been renamed to “metabolic dysfunction–associated steatohepatitis” (MASH). This article uses the name “MASH” throughout. MASH causes progressive inflammation of the liver that can lead to damage, severe scarring of the liver (“cirrhosis”), and ultimately, liver cancer. Researchers are interested in understanding the experiences of people living with MASH, including the symptoms and daily life impacts of MASH. NASH-CHECK is a questionnaire that was first designed for people with the early stages of MASH, without severe scarring of the liver, to describe their symptoms and the impacts that MASH has on their quality of life. The purpose of this study was to understand whether NASH-CHECK is appropriate for people with MASH that has progressed to the first stage of severe liver scarring (“compensated cirrhotic MASH”). After interviewing 33 people in the United States and the United Kingdom to understand their experiences with MASH without severe liver scarring and after consulting with doctors who treat people with MASH, the researchers found that NASH-CHECK was suitable for people with MASH that has progressed to the first stage of severe liver scarring. NASH-CHECK then was tested with 17 people with compensated cirrhosis due to MASH, who confirmed that the questionnaire allowed them to describe the symptoms and impacts they experienced from MASH. People with MASH that has progressed to the first stage of severe liver scarring can use NASH-CHECK to evaluate the symptoms and impacts of MASH, which will help doctors and researchers to understand how people with this disease feel and function.

The online version contains supplementary material available at 10.1186/s41687-025-00881-6.

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