Clinical and ultrasound markers of significant liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease and arterial hypertension

Abstract

Objective — to identify clinical, laboratory, and ultrasound markers of significant liver fibrosis in patients with metabolic dysfunction‑associated steatotic liver disease (MASLD) and arterial hypertension. Materials and methods. The study was conducted at two healthcare institutions and had a prospective design. Patients attending outpatient gastroenterology clinics were enrolled if clinical, metabolic, laboratory, or ultrasonographic signs of steatotic liver disease were detected during examination. All patients underwent liver ultrasonography with shear‑wave elastography. Significant fibrosis was defined as liver stiffness ≥ 8.0 kPa, while severe fibrosis was defined as ≥ 12.0 kPa, in accordance with conventional thresholds used in algorithms for the non‑invasive assessment of fibrosis in MASLD. Results. A total of 200 patients with a steatotic liver phenotype were enrolled in the study. After applying the exclusion criteria and selecting the hypertensive subgroup, 181 patients were included in the study group. The median [Q1; Q3] age was 46.0 [39.0; 57.0] years, body mass index (BMI) was 27.14 [23.90; 30.32] kg/m2, systolic blood pressure was 150 [140; 170] mmHg, diastolic blood pressure was 90 [90; 100] mmHg, and liver stiffness was 5.9 [4.7; 8.2] kPa. Significant fibrosis was detected in 47 patients (26.0%; 95% confidence interval (CI) 19.9 — 32.6), whereas severe fibrosis was detected in 20 patients (11.0%; 95% CI 6.9 — 16.0). In the significant fibrosis group, BMI was higher: 28.6 [24.95; 31.25] versus 26.31 [23.59; 30.00] kg/m2 (p=0.035). A coarse liver parenchymal echotexture was observed more frequently: 23.4% (95% CI 12.3 — 36.8) versus 2.2% (95% CI 0.4 — 5.5) (p<0.001), and hepatomegaly was observed in 78.7% (95% CI 65.6 — 89.3) versus 54.5% (95% CI 45.9 — 62.9) (p=0.006). According to the multivariable analysis, a coarse liver parenchymal echotexture was an independent predictor of significant fibrosis (OR 11.22; 95% CI 2.76 — 45.59; p=0.001). Conclusions. In patients with MASLD and arterial hypertension, significant fibrosis was present in one in four patients, while severe fibrosis was present in more than one in ten. A coarse liver parenchymal echotexture and hepatomegaly were associated with significant fibrosis; however, only a coarse liver parenchymal echotexture was an independent ultrasonographic predictor of significant fibrosis according to multivariable logistic regression analysis.