Discriminative performance of non-invasive scoring systems for VCTE-defined steatosis and fibrosis in patients with psoriasis.

Abstract

Background and aim: Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis. Reliable non-invasive tools are needed to evaluate hepatic steatosis and to identify patients at risk for significant liver fibrosis. This study aimed to assess the discriminative performance of commonly used non-invasive scoring systems for identifying patients with vibration-controlled transient elastography (VCTE)-defined significant liver fibrosis and hepatic steatosis in patients with psoriasis.

Materials and methods: A total of 113 patients with psoriasis were prospectively enrolled. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed using VCTE. Significant fibrosis (F2-F4) was defined as LSM ≥8 kPa, and significant steatosis (S2-S3) as CAP ≥259 dB/m. The discriminative performance of non-invasive fibrosis and steatosis scores was evaluated using area under the receiver operating characteristic (AUROC) curves.

Results: Of the 113 patients, 76 (67%) were diagnosed with MASLD following VCTE assessment. The body mass index, aspartate aminotransferase-alanine aminotransferase ratio, and diabetes (BARD) score (AUROC=0.692) showed the highest performance in identifying significant fibrosis, while FIB-4, aspartate aminotransferase to platelet ratio index, non-alcoholic fatty liver disease fibrosis score (NFS), and steatosis-associated fibrosis estimator (SAFE) demonstrated lower predictive accuracy. Among patients with MASLD, the SAFE score (AUROC=0.776), followed by the BARD score (AUROC=0.716), yielded the highest discriminative performance. The SAFE score showed the highest negative predictive value (95%) for ruling out significant fibrosis in MASLD patients. For detecting significant steatosis, the fatty liver index (FLI) score (AUROC=0.867) provided the highest performance, while hepatic steatosis index (HSI) (AUROC=0.813) and metabolic dysfunction-associated fatty liver disease screening score (MAFLD-S) (AUROC=0.833) also demonstrated good discriminative ability.

Conclusion: In patients with psoriasis, commonly used non-invasive fibrosis scores showed limited discrimination for VCTE-defined significant fibrosis, but they may have value as rule-out tools in low-prevalence settings. In contrast, FLI, HSI, and MAFLD-S showed good discrimination for VCTE-defined significant hepatic steatosis.