Histopathological Assessment Using SAF Scoring: Investigating Risk Factor Correlations with Disease Severity in MASLD Patients.

OBJECTIVE

To investigate risk factors associated with significant histologic lesions in metabolic dysfunction-associated steatotic liver disease (MASLD) using the SAF (Steatosis, Activity, Fibrosis) scoring system and to develop a risk prediction model.

METHODS

In this retrospective cohort of 415 biopsy-proven MASLD patients (2018-2022), participants were stratified into significant lesion (SAF activity grade ≥ 3 and/or fibrosis stage ≥ 3, n = 131) and non-significant lesion (activity < 3 and fibrosis < 3, n = 284) groups. Demographic, laboratory, and imaging parameters including platelet count (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), total bile acids (TBA), triglycerides (TG), total cholesterol (TC), fasting plasma glucose (FPG), uric acid (UA), laminin (LN), hyaluronic acid (HA), procollagen type III (PC-III), collagen type IV (C-IV), controlled attenuation parameter (CAP), and liver stiffness measurement (LSM) were analyzed.

RESULTS

Patients with significant lesions had higher body mass index (BMI), proportion of high-fat diet, AST, ALT, TBA, UA, CAP, and LSM (all P < 0.05). Multivariate logistic regression identified BMI ( OR = 1.182), UA ( OR = 1.003), CAP ( OR= 1.005), and LSM ( OR = 1.104) as independent predictors of significant histologic lesions, with a model area under the curve of 75.18%.

CONCLUSION

BMI, hyperuricemia, hepatic steatosis (CAP), and fibrosis (LSM) are independent risk factors for advanced MASLD. A combined non-invasive assessment may enhance risk stratification in clinical practice.