SAT-679 Fast Score Vs. Fib-4: Identifying At-risk Mash In Type 2diabetes And Masld

Abstract Disclosure: S.A. Alnashaba: None. Y. Elamin: None. M. Ismail: None. R. Al Argan: None. Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most prevalent chronic liver disease globally. A subset of patients develop metabolic dysfunction-associated steatohepatitis (MASH), which may progress to cirrhosis and hepatocellular carcinoma. Early identification of patients at risk for MASH and advanced fibrosis is critical for prognosis and intervention. Non-invasive tools such as the Fibrosis-4 (FIB-4) index and FibroScan-AST (FAST) score show promise, but their performance in patients with type 2 diabetes (T2D) and MASLD remains uncertain. Aim: To assess the utility of the FAST score in identifying at-risk MASH and predicting advanced fibrosis in T2D patients with MASLD, compared to the FIB-4 index. Methods: This retrospective cohort study included 273 adults with T2D who underwent FibroScan between August 2021 and July 2023 at King Fahad Hospital of the University. Patients with viral hepatitis, alcohol use, or secondary causes of liver disease were excluded. Steatosis and fibrosis were assessed using vibration-controlled transient elastography (CAP ≥248 dB/m; LSM ≥9.7 kPa for advanced fibrosis). FAST and FIB-4 scores were calculated. Diagnostic accuracy was assessed using AUROC, sensitivity, specificity, and predictive values. Multivariate logistic regression was used to identify predictors. IRB approval was obtained. Results: Among 273 patients (mean age 52.9±12.8 years; 54.9% female), 26.4% had advanced fibrosis by FAST score. High FAST scores were associated with obesity, elevated liver enzymes, HbA1c ≥7, and lower albumin and platelet levels (p<0.05). FAST score showed higher AUROC (0.936 vs. 0.711), sensitivity (82.0% vs. 48.0%), and NPV (95.5% vs. 87.8%) than FIB-4 for detecting LSM-defined advanced fibrosis. FAST also had stronger correlation with LSM (r=0.67 vs. 0.23) and greater overall diagnostic accuracy (85.4%). Conclusion: The FAST score is a robust non-invasive tool for detecting at-risk MASH and advanced fibrosis in patients with T2D and MASLD. It outperforms the FIB-4 index in diagnostic accuracy and may aid in early risk stratification. Larger prospective studies are warranted to validate its clinical utility in this high-risk population. Presentation: Saturday, July 12, 2025