Diagnostic utility of non-invasive tests for significant liver fibrosis in people with metabolic dysfunction-associated steatotic liver disease

Introduction The global rise in obesity and metabolic syndrome has increased metabolic dysfunction-associated steatotic liver disease (MASLD) incidence. Owing to its high prevalence and the emergence of new therapies, noninvasive tests (NITs) for liver fibrosis are becoming more widely used. Objectives The aim of this study was to analyze and compare NITs in identifying ≥F2 fibrosis in people with MASLD confirmed in liver biopsy. Patients and methods This study included a retrospective analysis of 134 patients. The accuracy of 9 NITs in identifying significant fibrosis was assessed and new thresholds were proposed using the Youden index. Results The group with ≥F2 fibrosis (52 patients) was older (P = 0.002) and had a higher BMI (P <0.001), lower platelet count (P <0.001), total cholesterol (P = 0.005) and albumin concentration (P = 0.02), and higher AST activity (P = 0.003) and INR (P = 0.02) than the group without significant fibrosis (82 patients). Areas under the ROC curve (AUROCs) above 0.8 were obtained for the NAFLD fibrosis score (0.818), Fibroscan (0.805), Hepamet score (0.803) and AST/ALT ratio (0.802). The highest sensitivity and negative predictive value were obtained for the FIB-4 and Hepamet score. The new optimal thresholds were lower than those previously presented in the literature, which was associated with an increase in their sensitivity and negative predictive value. Conclusions NITs for liver fibrosis are useful for identifying patients with significant fibrosis, but lower thresholds should be considered. The Hepamet score might be considered an alternative tool for FIB-4 in ruling out significant fibrosis in clinical practice.