External Validation of the Hepatic Steatosis Index for the Detection of Steatotic Liver Disease in Zambia

The hepatic steatosis index (HSI) is used to detect steatotic liver disease (SLD), but its diagnostic performance in African populations is unknown. We performed an external validation of HSI among adults in Zambia. We consecutively screened treatment-naïve people with HIV and individuals without HIV in Zambia using the controlled attenuation parameter (CAP) by vibration controlled transient elastography (VCTE). Model discrimination and calibration were assessed using the c-index and calibration plots. Among 401 participants, 161 (40.1%) were people with HIV. Median age was 37 years (interquartile range 32–43), 244 (60.9%) were female, and 131 (32.7%) were overweight or obese. VCTE-confirmed SLD was present in 41 (10.2%) participants, whereas 92 (22.9%) had an HSI ≥ 36. The c-index to diagnose SLD was 0.67 (95% confidence interval 0.56–0.77). The calibration plot indicated that HSI overestimated the risk for SLD. HSI showed a poor diagnostic performance for the detection of SLD among adults in Zambia.