Improving MASLD Identification in Patients with T2D: A Computable Phenotype Framework Integrating Structured Data and...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among individuals with type 2 diabetes (T2D), yet accurate identification from electronic health records (EHRs) remains challenging because clinically relevant information is fragmented across structured data and unstructured clinical documentation. We developed a rule-based computable phenotype (CP) framework that integrates structured EHRs with clinical notes for scalable MASLD identification in patients with T2D. The framework comprises five complementary CP algorithms derived from validated fibrosis indices and liver injury biomarkers, together with a lightweight natural language processing module that identifies MASLD-related evidence using keyword matching, contextual filtering, and negation detection. The proposed framework was systematically evaluated across multiple threshold settings, with additional validation through age- and sex-stratified analyses and manual chart review. The findings demonstrate that integrating structured and unstructured EHR data provides an accurate and scalable framework for real-world MASLD phenotyping and offers a practical strategy for developing CPs for other chronic diseases.