Profiles associated with significant hepatic fibrosis consisting of alanine aminotransferase >30U/L, exercise habits, and metabolic dysfunction-associated steatotic liver disease.

Abstract

In patients with steatotic liver disease (SLD), significant hepatic fibrosis is a prognostic factor with various etiologies, including inflammation and metabolic dysfunction. This study aimed to investigate independent factors and profiles associated with significant hepatic fibrosis, including alanine aminotransferase (ALT) levels >30U/L and metabolic dysfunction-associated SLD (MASLD), in health check-up examinees. This single-center, retrospective, observational cohort study enrolled 1378 consecutive health checkup examinees from April 2018 to September 2022. Shear wave elastography (SWE) was performed during a routine ultrasound examination, and patients with liver stiffness ≥6.60kPa were defined as having significant hepatic fibrosis. Patients were classified into nonsignificant hepatic fibrosis (n=1220) or a significant hepatic fibrosis (n=158) group according to this definition. In multivariate analysis, the independent factor for significant hepatic fibrosis was aging (≥65years; OR 9.637, 95% CI 6.704-13.852, p<0.0001). According to decision tree analysis, the initial classifier was aging (≥65years). After aging, an ALT level >30U/L was the second relevant factor for significant hepatic fibrosis, regardless of age. An undirected graphical model showed that an ALT level of >30U/L was directly associated with significant hepatic fibrosis. In patients aged ≥65years with an ALT level >30U/L, significant hepatic fibrosis was observed in 52% of the patients. Meanwhile, in patients aged ≥65years with an ALT level ≤30U/L, MASLD was the third classifier, with significant hepatic fibrosis observed in 38% of patients. ALT levels >30U/L and MASLD may be involved in the pathogenesis of significant hepatic fibrosis in patients aged ≥65years.