Cardiometabolic Biomarkers for Disease Severity Prediction in Metabolic Dysfunction‐Associated Steatotic Liver Disease

The impacts of cardiometabolic risk factors (CMRFs) and the biomarkers on disease severity in metabolic dysfunction‐associated steatotic liver disease (MASLD) remain elusive. Accordingly, a multicenter study by recruiting MASLD patients from a nationwide registry database was conducted with a total of 2882 MASLD patients (54.1% males, mean age = 55.6 ± 13.9 years, mean body mass index [BMI] = 28.1 ± 4.9 kg/m 2 ) being recruited. The proportions of patients carrying CMRFs of overweight/obesity, hypertension, hypertriglyceridemia, low high‐density lipoprotein cholesterol level, and diabetes/prediabetes were 91.2%, 74.5%, 54.8%, 59.6%, and 74.5%, respectively. There was a significant linear trend between significant fibrosis and CMRFs (5.1%, 27%, and 54.6% in patients with one CMRF, 3 CMRFs, and ≥ 4 CMRFs, respectively, p = 0.009). The adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for advanced fibrosis in patients of hemoglobin A1c (HbA1c) 5.7%–6.5%, 6.5%–8.0%, and > 8.0% were 1.02 (95% CI = 0.68–1.53, p = 0.93), 1.83 (95% CI = 1.16–2.88, p = 0.01), and 2.78 (95% CI = 1.45–5.34, p = 0.002), respectively. The significant risk factors for advanced fibrosis in MASLD were age > 60 years (aOR = 12.08, 95% CI = 6.23–23.46, p < 0.001), elevated transaminase level (aOR = 1.06, 95% CI = 1.05–1.09, p < 0.001), and diabetes (aOR = 1.51, 95% CI = 1.02–2.26, p = 0.04). In conclusion, there was a significant linear association between advanced fibrosis and the items of CMRFs. The HbA1c level could serve as a predictive biomarker for advanced fibrosis in MASLD with the implication that diabetes control is mandatory for patients with MASLD.