Ultrasound-Derived Fat Fraction and Metabolic Parameters in Predicting Panvascular Disease Risk in Metabolic...

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at increased risk of panvascular disease (PD). Noninvasive markers for early risk stratification are needed. We evaluated whether ultrasound-derived fat fraction (UDFF) improves the prediction of PD occurrence in MASLD patients.

In this prospective cohort, 525 adults with MASLD were enrolled between October 2022 and December 2023 and followed for 6 months for PD occurrence. Baseline UDFF and clinical/metabolic variables were collected. Multivariable logistic regression analyses reported standardized coefficients (per-standard deviation [SD] β) and odds ratios (ORs) per 1-SD (OR). A decision tree model was constructed to explore differences across metabolic subgroups, including obesity, hypertension, diabetes, and multiple metabolic abnormalities. Discriminative performance was compared using the area under the curve (AUC; DeLong test).

Body mass index (BMI), systolic blood pressure (SBP), homeostasis model assessment of insulin resistance (HOMA-IR), and UDFF were each associated with increased PD risk. In the multivariable model, the strongest standardized effects were observed for UDFF (β=3.28; OR, 2.10; 95% confidence interval [CI], 1.45 to 2.75) and BMI (β=1.87; OR, 1.68; 95% CI, 1.25 to 2.34), followed by SBP (β=1.33; OR, 1.15; 95% CI, 1.03 to 1.26). HOMA-IR (β=0.96; OR, 1.65; 95% CI, 1.30 to 2.15), age (β=0.56; OR, 1.06; 95% CI, 1.01 to 1.12), and liver stiffness measurement (β=0.14; OR, 1.03; 95% CI, 1.01 to 1.07) also showed smaller but significant associations. The decision tree model reflected similar patterns and achieved higher discrimination than logistic regression (AUC 0.85 vs. 0.80, P<0.05).

UDFF is a key predictor of PD risk in MASLD patients, underscoring the importance of risk stratification for early intervention and personalized management strategies.