Risk Stratification of a Novel Noninvasive Fibrosis Score in Metabolic Dysfunction-associated Steatotic Liver Disease

Risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD) may identify high-risk groups for early intervention to reduce liver-related complications. We examined the prognostic accuracy of the MAFLD fibrosis score (MFS) in predicting risks of liver-related events and mortality among patients with MASLD.

This prospective cohort study with a median follow-up period of 9.7 years included 683 patients with biopsy-proven MASLD at 2 tertiary centers in Malaysia and Hong Kong. Noninvasive scores, including MFS, were computed using routine clinical data. Cumulative incidences of any liver-related events and all-cause mortality were compared between patients at low (MFS <15) and high risk (MFS ≥15) with Kaplan-Meier estimation and Cox regression.

With mean age 52.0 ± 11.8 years and 53.0% male, the high-risk group had an incidence of liver-related events of 844 (95% confidence interval [CI], 436-1475) and all-cause mortality of 1532 (95% CI, 948-2341), compared with 75 (95% CI, 21-193) and 383 (95% CI, 234-592) per 100,000 person-years in the low-risk group, respectively. The hazard ratios were 9.90 (95% CI, 3.19-30.76) for liver-related events and 4.13 (95% CI, 2.22-7.69) for all-cause mortality. MFS outperformed other noninvasive scores, including vibration-controlled transient elastography, in predicting liver-related events and all-cause mortality at 15-year follow-up (area under receiver operating characteristic curve 0.916 and 0.698). A single cutoff of MFS≥15 demonstrated sensitivity of 77.2% and specificity of 94.3% in predicting liver-related events and 41.4% and 94.8% in predicting mortality.

MFS optimally stratifies patients with MASLD with high risk for developing long-term liver-related events and mortality.