Serum fibrosis scores as predictors of liver fibrosis and long-term outcomes in metabolic dysfunction-associated steatotic liver disease, including cirrhosis

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is commonly linked to liver fibrosis, which may progress to cirrhosis. FIB-4, APRI, and NFS are used to predict fibrosis severity, but their accuracy and role in long-term outcomes remain unclear. OBJECTIVES: This study evaluates the predictive value of these scores for fibrosis and assesses the incidence of de novo cirrhosis and survival outcomes in MASLD patients. METHODS: This retrospective, single-center study included 175 MASLD patients in our university medical center. The diagnostic performance of FIB-4, APRI, and NFS for advanced fibrosis (stage 3-4) was assessed using receiver operating characteristic (ROC) analysis. Cox regression analysis was performed to evaluate factors associated with de novo cirrhosis and survival outcomes. RESULTS: The mean age was 49.9±14.1 years, and 54.9% were female. The median follow-up was 78 months. ROC analysis showed FIB-4 (AUC: 0.77) was the best predictor of advanced fibrosis, followed by APRI (AUC: 0.74) and NFS (AUC: 0.74). Multivariate analysis identified fibrosis stage (HR: 3.045, p=0.001) and hypertension (HR: 4.096, p=0.047) as independent predictors of de novo cirrhosis. Age (HR: 1.070, p=0.031), albumin (HR: 15.151, p<0.001), and HbA1c (HR: 1.589, p<0.001) were independently associated with survival. CONCLUSION: FIB-4 was the most accurate predictor of advanced fibrosis. Fibrosis stage and hypertension were the strongest predictors of de novo cirrhosis. These findings highlight the importance of fibrosis staging and comorbidity management in MASLD.