Real-World Feasibility of Fibrosis-4-Based Fibrosis Risk Stratification in Patients With Type 2 Diabetes Mellitus and Metabolic Dysfunction-Associated Steatotic Liver Disease

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM), a population at increased risk for advanced liver fibrosis. Current guidelines recommend the Fibrosis-4 (FIB-4) index as a first-line fibrosis risk stratification tool; however, its implementation in routine clinical practice remains uncertain. Aim To evaluate the real-world feasibility of FIB-4-based fibrosis risk stratification in patients with T2DM and MASLD. Methods We conducted a retrospective cross-sectional study including adult outpatients with T2DM and MASLD evaluated at a national referral center in Santo Domingo, Dominican Republic, between March 2022 and January 2025. Feasibility was defined as the proportion of patients with sufficient laboratory data to calculate FIB-4. Results A total of 397 patients were included. Only 143 patients (36.0%) had complete laboratory data required for FIB-4 calculation, while 254 (64.0%) lacked at least one required variable. AST and ALT were the most frequently missing laboratory parameters. Among patients with calculable FIB-4 values, 16 (11.2%) were classified as high risk for advanced fibrosis according to age-adjusted thresholds. Conclusions In this real-world cohort of patients with T2DM and MASLD, guideline-recommended FIB-4-based fibrosis risk stratification showed limited feasibility due to incomplete routine laboratory data. These findings highlight opportunities to improve the integration of standardized fibrosis risk assessment into routine diabetes care.