Clinical and laboratory characteristics associated with ascites in patients with MASLD-related cirrhosis: a cross-sectional study.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent condition globally. It is underexplored in Saudi Arabia, particularly its clinical and biochemical factors associated with hepatic decompensation (ascites) among MASLD-related cirrhosis. The objective is to describe and compare the demographic, clinical, biochemical, and laboratory profile of MASLD-related cirrhosis in the presence or absence of ascites. The importance of routine monitoring correlated with hepatic decompensation was also explored.

METHODS: This cross-sectional study was conducted, in which data were collected from hepatology electronic medical records at King Abdulaziz University Hospital for patients managed between January and July 2025. Eligible adults (≥18 years) had MASLD-related cirrhosis, defined by hepatic steatosis on imaging with at least one cardiometabolic risk factor and exclusion of other liver disease aetiologies, with cirrhosis confirmed by ultrasound, computed tomography (CT), transient elastography, or biopsy. Patients were classified by presence or absence of ascites, diagnosed clinically and/or by ultrasound. Demographic, anthropometric, haematological, and biochemical variables, together with the fibrosis-4 (FIB-4) index and non-alcoholic fatty liver disease (NAFLD) Fibrosis Score (NFS), were compared between groups using independent-samples t-tests (with Welch correction where indicated) and chi-square/Fisher's exact tests. Binary logistic regression was used to explore associations between clinical/laboratory variables and the presence of ascites, using SPSS version 27.

RESULTS: There were 41 MASLD cirrhosis patients (56.1% women, 68.3% Saudi): 14 (34.1%) with ascites and 27 (65.9%) without. Patients with ascites had significantly lower serum albumin (33.25±8.05 vs. 39.50±6.35 g/L; P=0.01) than those without; platelet counts (102.25±46.69 vs. 164.42±116.08 ×109/L) and aminotransferases were numerically lower in the ascites group but did not reach statistical significance in bivariate comparison than those without ascites. In exploratory binary logistic regression, higher body mass index (BMI) showed a trend toward association with ascites that did not reach statistical significance [odds ratio (OR) 1.175, 95% confidence interval (CI): 0.998-1.385, P=0.054]; lower white blood cell (WBC) count (OR 0.315, P=0.01), lower alanine aminotransferase (ALT) (OR 0.832, P=0.03), and lower albumin (OR 0.790, P=0.01) were independently associated with ascites, these estimates should be interpreted with caution, as confidence intervals were wide and the model may be unstable.

CONCLUSIONS: In this cross-sectional sample of Saudi patients with MASLD-related cirrhosis, lower serum albumin, lower ALT, and lower white cell count were associated with the presence of ascites; higher BMI showed a similar trend that did not reach significance. Given the cross-sectional design and small number of ascites cases, these findings should be interpreted as exploratory associations rather than predictors of decompensation, and do not by themselves support a claim that monitoring or modifying these markers would prevent progression to ascites. Larger, prospective, longitudinal studies are needed to determine whether these markers have predictive value for incident decompensation.