Prevalence and Predictors of Hepatic Steatosis in Patients Undergoing Sleeve Gastrectomy: A Biopsy-proven Study

Abstract To date, there is a lack of population-based studies assessing the prevalence and severity of steatosis and metabolic-associated steatohepatitis (MASH) in Egypt. CAP is widely used as a non-invasive tool for hepatic steatosis assessment, yet its reliability in obese populations remains unclear. We aimed to examine the prevalence and risk factors for steatosis and steatohepatitis in Egyptian patients undergoing laparoscopic sleeve gastrectomy and evaluate CAP’s diagnostic accuracy against liver biopsy in detecting hepatic steatosis. Methods: In this prospective cross-sectional study (2019–2023), 162 obese adults undergoing bariatric surgery were enrolled. CAP was performed prior to intraoperative wedge liver biopsy. Histological grading of steatosis and NAS scoring were conducted by blinded pathologists. Diagnostic accuracy of CAP was evaluated using AUROC, sensitivity, specificity, PPV, and NPV. Results: Hepatic steatosis was present in 63.6% of patients by liver biopsy. CAP overestimated steatosis in 40% of biopsy-confirmed S0 cases, misclassifying them as S3. CAP cutoff of 286 dB/m for ≥ S1, sensitivity, specificity, PPV, and NPV were 57.7%, 65.0%, 76.3%, and 44.1%, respectively (AUROC = 0.577). Only 14.2% had steatohepatitis. Multivariate analysis identified albumin ( p = 0.040) and hemoglobin ( p = 0.018) as independent protective factors. Conclusion: CAP significantly overestimated steatosis severity highlighting its limited reliability in obese populations.