Association Between Hepatorenal Index and Arterial Stiffness in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated fatty liver disease (MASLD) is currently the most common chronic liver disease and is closely related to cardiovascular diseases. The aim of this study is to investigate the relationship between the hepatorenal index (HRI), a non-invasive indicator of hepatic steatosis, and arterial stiffness and cardiovascular risk. Between March and June 2025, 93 patients diagnosed with MASLD were prospectively included in the study. Demographic and biochemical parameters were recorded. Arterial stiffness was measured using the Mobil-O-Graph PWA device, and pulse wave velocity (PWV) and augmentation index (AIx) were calculated. Cardiovascular risk was assessed using the SCORE2-Turkey algorithm. HRI was measured by ultrasound and compared with shear wave elastography (SWE), AST-platelet ratio index (APRI), and fibrosis 4 score (FIB-4). A significant, positive, and moderate correlation was found between HRI and PWV (r = 0.405, p < 0.001). A weak but significant relationship was detected between SCORE2 and HRI (r = 0.228, p = 0.028). A positive correlation was observed between HRI and triglycerides and total cholesterol, but not with HDL/LDL. A negative relationship was found between age and HRI (r = –0.306, p = 0.003). No significant correlation was observed between HRI and SWE, APRI, and FIB-4. In multivariate analysis, PWV and triglyceride levels were determined to be independent predictors of HRI. HRI may be associated not only with steatosis in patients with MASLD but also with arterial stiffness and cardiovascular risk. Therefore, HRI may be considered a non-invasive, practical, and low-cost complementary tool in cardiovascular risk prediction.