[Noninvasive scores for predicting liver-related events in patients with metabolic dysfunction-associated fatty liver...

Objective: To evaluate the predictive value of noninvasive fibrosis scores for liver-related events (LREs) in metabolic dysfunction-associated fatty liver disease (MAFLD). Methods: Patients with biopsy-confirmed MAFLD who were treated at Beijing Friendship Hospital between 2018 and 2024 were prospectively enrolled and followed up. Demographic and laboratory data were collected. The noninvasive measures and fibrosis scores evaluated in this study included liver stiffness measurement (LSM) based on transient elastography, the aspartate aminotransferase-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4) index, NAFLD fibrosis score (NFS), Agile3+, Agile4, and FibroScan-AST (FAST) score. LREs were defined as the first occurrence of decompensated cirrhosis, hepatocellular carcinoma, liver disease-related death, liver transplantation, or clinically significant portal hypertension (noninvasively according to the Baveno VII consensus criteria). Continuous variables were compared between the two groups using the Wilcoxon rank-sum test. Risk stratification was performed based on the cutoff values for each baseline noninvasive score. Kaplan-Meier analysis was used to compare cumulative incidences of LREs across risk strata. Cox regression analysis was used to assess the predictive value of each score for LREs, while receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to evaluate the predictive performance of each noninvasive score for 3-year LREs. Results: Data from 226 biopsy-confirmed MAFLD patients were included. Among them, 70 (31.0%) were male, and the median age was 54 (41, 61) years. The median follow-up duration was 36 months. A total of 22 (9.7%) LRE occurred. The LRE group exhibited higher baseline levels of total bilirubin, creatinine, LSM, and all noninvasive scores, as well as a higher prevalence of diabetes but lower platelet counts (P<0.01). The median values of LSM and all noninvasive scores were consistently higher at various time points during follow-up in the LRE group than in the non-LRE group. Risk stratification results showed that the high-risk groups for each noninvasive score had the highest 3-year cumulative incidence of liver-related events (LREs) (LSM ≥15.0:39.4%; APRI≥1.5:27.3%; FIB-4>2.67:31.6%; NAFLD fibrosis score >0.676:37.8%; FAST≥0.67:22.1%; Agile3+≥0.679:27.3%; Agile4≥0.565:35.9%), all of which were significantly higher than those in the low- and intermediate-risk groups (P<0.01). Univariate Cox regression analysis indicated that LSM and all non-invasive scores were significantly associated with an increased risk of LREs [LSM: hazard ratio (HR)=2.44, 95% confidence interval (CI): 1.88-3.17; APRI: HR=1.74, 95%CI:1.30-2.33; FIB-4: HR=1.80, 95%CI:1.45-2.24; NAFLD fibrosis score: HR=3.79, 95%CI:2.44-5.89; Agile3+:HR=17.66, 95%CI:4.79-65.07; Agile4:HR=3.39, 95% CI: 2.24-5.13; FAST: HR=2.88,95%CI:1.63-5.10]. Multivariate Cox regression analysis showed that all noninvasive scores remained significantly associated with an increased risk of LREs after further adjustment for baseline age, sex, body mass index, diabetes, and hypertension (P<0.05). Conclusion: Patients with MAFLD who had high-risk baseline LSM values and noninvasive liver fibrosis scores had a significantly increased risk of developing LREs.