Clinical Risk Factors for Advanced Fibrosis in Pathology‐Proven Steatotic Liver Disease: Emphasis on Nonelder Subjects

Background and Aim Steatotic liver disease (SLD) may lead to advanced liver diseases. We aimed to identify clinical risk factors for advanced fibrosis in pathology‐proven SLD patients in a hepatitis B virus (HBV) endemic population, with emphasis on nonelder subjects. Methods Adult SLD patients diagnosed via pathology at National Taiwan University Hospital between June 2009 and December 2023 were recruited. Advanced fibrosis was defined as F2 to F4 fibrosis. Patients were stratified by age (< 50 years defined as nonelder), metabolic dysfunction‐associated steatotic liver disease (MASLD), and HBV infection. Clinical risk factors for advanced fibrosis and at‐risk steatohepatitis were investigated, and the predictive performance of noninvasive scores was examined. Results Among 223 pathology‐proven SLD patients, older age (odds ratio [OR]: 1.04), alcohol consumption (OR: 5.77), type 2 diabetes mellitus (T2DM) (OR: 2.13), chronic HBV infection (OR: 2.52), and obesity (OR: 2.64) were independent risk factors for advanced fibrosis. In the nonelder subgroup, older age (OR: 1.10) and obesity (OR: 3.75) were significant. In the MASLD subgroup, older age (OR: 1.04), hypertension (OR: 2.31), T2DM (OR: 3.07), and chronic HBV infection (OR: 3.59) remained significant. Obesity (OR: 4.14) was a significant risk factor for at‐risk steatohepatitis in the nonelder subgroup. NAFLD fibrosis score had the highest AUROC (0.724) for advanced fibrosis in the entire cohort, while FIB‐4 performed best in nonelder subjects. Conclusions Older age, alcohol, T2DM, chronic HBV infection, and obesity were associated with advanced fibrosis. Risk factors and noninvasive score performance varied in nonelder subjects.