Diagnostic Accuracy of Serum-Based Fibrosis Scores for Clinically Significant Liver Fibrosis in an East Asian Cohort.

Serum-based fibrosis scores are widely used for noninvasive risk stratification in chronic liver disease; however, direct comparisons across liver disease etiologies remain limited, particularly in Asian populations with a high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. This study retrospectively analyzed the data of adults who underwent transient elastography (FibroScan) at a university-affiliated hospital. Three fibrosis scores were evaluated: Fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and metabolic dysfunction-associated fibrosis-5 (MAF-5). Associations with advanced fibrosis (F3-F4) were examined using logistic regression. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Of the 2355 participants, the etiologic subgroups included metabolic dysfunction-associated steatotic liver disease (MASLD; n = 1070), HBV infection (n = 1459), and HCV infection (n = 250); 10.4% of the participants had advanced fibrosis (F3-F4). In the overall cohort, all scores were significantly associated with advanced fibrosis (p < 0.001) and demonstrated similar overall discrimination with AUROC in a range of 0.824-0.839. MAF-5 had the highest AUROC (0.839; 95% confidence interval [CI], 0.811-0.867) and greater risk classification compared with FIB-4 (net reclassification improvement = 0.168; 95% CI, 0.093-0.244). Subgroup analysis revealed that MAF-5 exhibited consistent discrimination across etiologies, with AUROCs of 0.822 (0.781-0.863) in MASLD, 0.843 (95% CI, 0.804-0.882) in HBV, and 0.810 (95% CI, 0.735-0.886) in HCV. Commonly used serum-based fibrosis scores exhibited comparable discrimination for advanced fibrosis. However, the metabolically informed MAF-5 score modestly improved risk classification across diverse liver disease etiologies.