Risk Stratification of Patients with Metabolic Dysfunction-associated Steatotic Liver Disease: Steatohepatitis, Fibrosis, and Hepatocellular Carcinoma

The metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is increasing globally, creating a growing public health concern. Metabolic disorders such as central obesity, dyslipidemia, hypertension, and hyperglycemia are intimately related to MASLD. Advanced hepatic fibrosis is the main predictor of morbidity, liver-related complications, and deaths. Various noninvasive scoring systems are used to practice acceptable general population screening and diagnose patients with MASLD. Unfortunately, as of right now, no single diagnostic test is thought to be reliable enough to diagnose and monitor MASLD patients. Liver biopsy remains the gold standard for diagnosing metabolic dysfunction-associated steatohepatitis (MASH) (with or without fibrosis), impacting the prognosis and survival of patients with MASLD.

Moreover, it is anticipated that MASLD is a risk factor for hepatocellular carcinoma (HCC) development, and several risk factors for MASLD occurrence are also linked to the development of HCC. Identifying patients with a risk of developing MASH, fibrosis, and HCC is more challenging; there is limited evidence on utilizing available noninvasive methods for these purposes. This review discusses the tools and steps of risk stratification in MASLD patients, providing data to guide the utilization of various diagnostic and scoring tools, focusing on the latest techniques to non-invasively detect patients at risk of developing MASH, fibrosis, and HCC.