Hepatic Steatosis Index (HSI): A Valuable Biomarker in Subjects with Metabolic Dysfunction-associated Fatty Liver Disease (MAFLD)

Introduction and Objectives

Metabolic Dysfunction-associated Fatty Liver Disease (MAFLD) has been recognized as the hepatic component of metabolic syndrome and has become a growing public health concern. Early and accurate detection of MAFLD is crucial for implementing appropriate intervention strategies and preventing progression to serious complications such as liver cirrhosis. We aimed to describe the diagnostic performance of the Hepatic Steatosis Index (HSI) in subjects with MAFLD and compare it with the Homeostatic Model Assessment of Insulin Resistance (HOMA), Waist-to-Hip Ratio (WHR), and Visceral Fat (SECA).

Materials and Methods

Retrospective design study. Bioanthropometric, clinical, and biochemical variables were collected. The HSI was calculated using the formula HSI = 8 * ALT/AST + BMI + 2 (if diabetic) + 2 (if female). ROC curves and their areas were generated. Statistical significance was determined at p < 0.05.

Results

A total of 585 subjects were evaluated, of whom 279 were classified with MAFLD (65.5% females) and 306 without MAFLD (76.8% females). Subjects with MAFLD exhibited higher values of age, BMI, WHR, HOMA, CAP, and HSI (Table 1). The HSI showed a diagnostic performance with an area under the curve (AUC) of 0.80. A cutoff point of 39.9 was established for the HSI, with a sensitivity of 63%, specificity of 74%, positive predictive value (PPV) of 73%, and negative predictive value (NPV) of 64%. The HSI demonstrated superior diagnostic performance compared to visceral fat (0.70), HOMA (0.70), and WHR (0.66) (Fig 1).

Conclusions

The results of this study demonstrate that HOMA, visceral fat, and ICC can be useful as screening strategies in MAFLD. However, the Hepatic Steatosis Index (HSI) showed superior diagnostic performance compared to the other evaluated biomarkers. Therefore, it is suggested that HSI be considered a useful diagnostic tool in MAFLD.