Are elevated hepatic fibrosis indicators (NFS and FIB-4) associated with an increased risk of subclinical carotid atherosclerosis in patients with MASLD?
Elevated hepatic fibrosis scores (NFS and FIB-4) are independently associated with an increased risk of subclinical carotid atherosclerosis in patients with MASLD, particularly in those under 50 years of age.
OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) and subclinical carotid atherosclerosis (SCA) share common roots in systemic inflammation and metabolic dysregulation. Hepatic fibrosis mirrors the intensity of these disturbances; however, its association with SCA in younger adults remains unclear. METHODS: A total of 14 567 MASLD patients were enrolled from the health examination center of Northern Jiangsu People's Hospital. Participant stratification into SCA and non-SCA groups was based on carotid ultrasound findings. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression. The associations between the selected indicators and SCA risk were subsequently evaluated through multivariate logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, receiver operating characteristic (ROC) curves, and mediation analysis. RESULTS: Both LASSO and multivariate logistic regression analyses demonstrated that elevated NAFLD Fibrosis Score (NFS) and Fibrosis-4 (FIB-4) levels were positively correlated with the prevalence of SCA in patients with MASLD (P for trend < 0.001). Mediation analysis indicated that the Red-cell Distribution Width-to-Albumin Ratio (RAR) significantly mediated this association, with the mediated proportion ranging from 28.6% to 44.6% (P < 0·05). Subgroup analysis identified a significant interaction between age and the association of both fibrosis scores with SCA (P for interaction < 0.05). Subsequently, RCS analysis demonstrated significant positive non-linear associations between NFS/FIB-4 and SCA risk specifically in patients aged under 50 years (P for non-linear < 0.001). The area under the ROC curve (AUC) indicated that both scores had fair predictive value for SCA in this younger subgroup. CONCLUSION: This study confirms that elevated NFS and FIB-4 levels are significantly associated with an increased risk of SCA in MASLD patients, demonstrating a distinct non-linear relationship and fair predictive value, particularly in individuals under 50 years of age.
Zhang et al. (Mon,) studied this question.