Comparison of the diagnostic performance of alanine aminotransferase and ultrasonography for discrimination of liver biopsy proven metabolic associated steatotic liver disease: a ROC curve analysis

MASLD is an increasingly prevalent cause of chronic liver disease worldwide, requiring accurate and accessible non-invasive diagnostic tools as its gold standard is liver biopsy. This study aimed to assess the diagnostic performance of ultrasound and alanine transaminase using liver biopsy as the reference standard to identify MASLD. Facility based cross-sectional study design was used. Sociodemographic data using a structured questionnaire, fatty liver diagnosis using imaging ultrasonography and ALT test using fasting venous blood were assessed from the study participants. The characteristics of study participants were assessed using chi-square and independent t-test. Ultrasound and ALT results were evaluated by ROC curve analysis and the AUC values compared using the DeLong test. Their sensitivity and specificity were analysed and cut-off value was determined using Youden index formula. The AUROC values were checked for age and sex with p -value < 0.05 taken for statistical significance. The AUC values of ALT and US were 0.91 (95% CI 0.87–0.95) and 0.83 (95% CI 0.76–0.9), respectively with ( p ≤ 0.001). The sensitivity and specificity of US were 82.02% and 96.6% at moderate and severe MASLD status. The sensitivity and specificity for ALT were 68.54% and 97.06% at the cut-off value of 34 IU/L. Ultrasound was the prioritized technique for the detection for MASLD, while ALT also had a good discriminating ability of MASLD. Both show highest discriminating ability of MASLD in male and female. Not applicable.