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

ABSTRACT 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.