Key result
Novel composite metabolic score outperforms individual indices for detecting significant hepatic steatosis with ~0.92 AUROC.
Why the study?
Non-invasive metabolic indices offer a pragmatic alternative to liver biopsy for screening MASLD, but systematic comparisons and superior composite scores were needed.
Does a novel composite score of metabolic indices improve diagnostic performance for ultrasonographic hepatic steatosis compared to individual indices in adults undergoing abdominal ultrasonography?
Cross-Sectional (n=1,204)
No
Does a novel composite score of metabolic indices improve diagnostic performance for ultrasonographic hepatic steatosis compared to individual indices in adults undergoing abdominal ultrasonography?
Effect estimate: AUROC 0.922 (95% CI 0.906-0.938)
p-value: p=0.004 vs. TyG
A novel composite score of four metabolic indices significantly outperforms individual indices for the non-invasive detection of ultrasonographic hepatic steatosis.
May enhance non-invasive steatosis detection in referred adults; hypothesis-generating pending prospective validation.
Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), is the most prevalent chronic liver condition globally, affecting one-quarter of the adult population. Non-invasive metabolic indices offer a pragmatic alternative to liver biopsy for population-level steatosis screening. We aimed to systematically compare the diagnostic performance of four widely used metabolic indices—TyG, LAP, FLI, and VAI—and to derive a novel composite score that demonstrably surpasses each constituent index. Methods: Retrospective cross-sectional study; 1204 consecutive adults undergoing abdominal ultrasonography at a single tertiary centre (study period: 2024–2025; data collection period: January–April 2026); steatosis graded 0–3 by certified radiologists; four metabolic indices retrieved from pre-calculated columns; novel composite score derived by binary logistic regression with 10-fold stratified cross-validation (stratified by binary outcome); AUROC with 1000-iteration bootstrap 95% CI; and pairwise comparisons by the DeLong method. Results: Of 1204 patients (mean age 42.3 ± 12.5 years; 73.3% male; 13.4% with diabetes), steatosis grades were: Grade 0, 185 (15.4%); Grade 1, 539 (44.8%); Grade 2, 311 (25.8%); and Grade 3, 169 (14.0%). For significant steatosis (Grade ≥ 2), TyG achieved AUROC 0.884 [0.863–0.904] and LAP 0.883 [0.862–0.901], while FLI showed only moderate performance. The novel composite score achieved AUROC 0.896 [0.870–0.920] for any steatosis and 0.922 [0.906–0.938] for significant steatosis, significantly outperforming all four individual indices (DeLong p = 0.004 vs. TyG; p = 0.002 vs. LAP; p < 0.001 vs. FLI; p < 0.001 vs. VAI). Youden-optimal performance: sensitivity 87.1%, specificity 86.0%, and Youden index 0.731. Conclusions: A 10-fold cross-validated logistic composite of four metabolic indices significantly outperforms each constituent index for ultrasonographic hepatic steatosis detection. The composite score may serve as a practical, non-invasive tool for steatosis risk stratification pending external validation.
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Altun et al. (2026) conducted a cross-sectional in Metabolic dysfunction-associated steatotic liver disease (MASLD) (n=1,204). Novel composite score of metabolic indices vs. TyG, LAP, FLI, and VAI indices was evaluated on Detection of significant steatosis (Grade ≥ 2) (AUROC 0.922, 95% CI 0.906-0.938, p=0.004 vs. TyG). A novel composite score of four metabolic indices significantly outperformed each constituent index for detecting significant hepatic steatosis (AUROC 0.922; 95% CI 0.906-0.938).
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