Reliability of Ultrasonic Hepatorenal Indices in Assessing Hepatic Steatosis: A Systematic Review and Meta‐Analysis

ABSTRACT The accuracy of the ultrasound hepatorenal index (HRI) in diagnosing hepatic steatosis has varied significantly in different clinical trials. Therefore, we conducted a meta‐analysis aimed at exploring the diagnostic accuracy of ultrasound HRI in the quantitative assessment of hepatic steatosis. Thirteen eligible studies published up to May 3, 2025, were obtained through a comprehensive search. We conducted a meta‐analysis using a random‐effects bivariate model to investigate the diagnostic accuracy of the ultrasound HRI in assessing hepatic steatosis. A total of 1496 cases were included that used liver biopsy or MRI‐PDFF as the reference standard to determine the presence of hepatic steatosis. We synthesized the sensitivity, specificity, likelihood ratio, diagnostic advantage ratio, and area under the curve of the included studies to assess the performance of the HRI as a diagnostic tool. The meta‐analysis demonstrated that ultrasound HRI had good performance in evaluating hepatic steatosis. However, there were significant differences in diagnostic performance and optimal cut‐off values among the included studies, indicating the need for consensus on the optimal cut‐off value for diagnosing hepatic steatosis. As an auxiliary means of ultrasonic analysis, ultrasonic HRI has achieved a good diagnostic effect in detecting hepatic steatosis.