The utility of emerging fibrosis scoring systems in MASLD: A paradigm shift toward non-invasive, multimodal risk stratification beyond histology.

ABSTRACT: Metabolic dysfunction-associated steatotic liver disease (MASLD) has undergone a major conceptual shift from a steatosis-centred condition to a disease spectrum, in which advanced fibrosis is the major prognostic determinant. It affects up to one-third of the adult population but remains asymptomatic in the majority of patients. Therefore, the efficient identification of at-risk individuals is a central clinical task. Non-invasive tests increasingly complement histological staging and are embedded in sequential diagnostic algorithms. In particular, FIB-4, as a first-line screening tool followed by vibration-controlled transient elastography for liver stiffness assessment, has been adopted by expert recommendations and clinical guidelines. ABSTRACT: These non-invasive tests have proven relevance to clinical endpoints beyond risk stratification and indications for MASLD-specific therapy. However, dynamic changes and their prognostic implications during treatment require further prospective evaluation. This review summarizes the current diagnostic strategies for MASLD and discusses their implementation in the German healthcare context.