Screening of advanced fibrosis and metabolic dysfunction-associated steatotic liver disease using transient elastography in vulnerable population

Liver cirrhosis is the primary contributor to global mortality associated with chronic liver diseases (CLD). Certain liver infections, including viral hepatitis B (VHB) and C (VHC), alcohol-related liver disease (ALD), and metabolic dysfunction-associated steatotic liver disease (MASLD) are significant contributors to the development of liver cirrhosis. This study aimed to evaluate the prevalence of liver steatosis and fibrosis in individuals with vulnerable conditions. Subjects residing in a rural Romanian county or having lower educational attainment were selected for this study. Following the acquisition of informed consent, a demographic, clinical, and physiological characterization was conducted for each participant. The AUDIT-C questionnaire was obtained from every participant. Transient Elastography (TE) measured liver fibrosis, while blood tests screened for the presence of hepatitis viruses B and C. Among the 571 screened vulnerable subjects, 52.7% were males, and 17.3% were identified as heavy drinkers. Metabolic syndrome was identified in 37.3% of patients and 70% of subjects exhibited a body mass index of ≥ 25 kg/m². Furthermore, 8.5% of participants tested positive for HBs antigen, while 6.1% had HCV antibodies. Additionally, 35.7% of the participants in our study had MASLD, and 7.1% had metabolic dysfunction and alcohol-related liver disease (MetALD) according to the AUDIT-C questionnaire. On TE exams, we found that 9.9% of the participants had advanced fibrosis, 16.1% had cirrhosis, and 24.5% had severe steatosis. Hence, the prevalence of advanced fibrosis and cirrhosis is elevated in asymptomatic healthy individuals from vulnerable conditions in Northeastern Romania, particularly among those with various risk factors. Most of the subjects were identified with MetALD and ALD demonstrating the efficacy of the new nomenclature in identifying the etiology of liver fibrosis.