Prevalence of Steatotic Liver Disease with Fibrosis and Diagnostic Screening Tools in Patients with Psoriasis

The prevalence of steatotic liver disease (SLD) with fibrosis in patients with psoriasis is unknown and no consensus on screening exists. Therefore, patients from The Copenhagen Translational Skin Immunology Biobank and Research Programme (BIOSKIN) were examined. SLD was defined as controlled attenuation parameter (CAP) > 250 dB/m and fibrosis as median liver stiffness measurement (LSM) ≥ 8 kPa using transient elastography. Biomarkers included fibrosis-4 index (FIB-4), N-terminal propeptide of collagen (type III), and enhanced liver fibrosis (ELF) test. A total of 403 patients (median age 51 years, 54% men, median BMI 27), 80% with moderate-to-severe psoriasis were enrolled. Based on the transient elastography, 40% of the patients had steatosis (mean CAP 245, ± 55 dB/m) and 5% had fibrosis (median LSM 4.8 kPa, IQR 3.8-5.8). According to self-reported alcohol consumption, all patients with steatosis except for 2 were categorized as having metabolic dysfunction-associated steatotic liver disease (MASLD). With transient elastography as the reference, FIB-4 and ELF had better diagnostic accuracy than PIIINP with Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% confidence interval 0.87-0.97) for FIB-4, 0.90 (0.83-0.97) for ELF test, and 0.77 (0.66-0.87) for PIIINP.