MASLD risk prediction in IBD: development of two tailored clinical scores
https://orcid.org/0000-0003-1460-6559
Robert Nastasa
https://orcid.org/0000-0002-8678-0663
Carol Stanciu
https://orcid.org/0000-0002-6427-4049
Cristina Muzica
https://orcid.org/0000-0003-0891-5961
Sebastian Zenovia
https://orcid.org/0000-0003-0441-3980
Ana Maria Singeap
https://orcid.org/0000-0001-5621-548X
Mihaela Dimache
Anca Victorita Trifan
https://orcid.org/0000-0001-9144-5520
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in patients with inflammatory bowel disease (IBD), but accurate, disease-specific predictive tools are lacking. This study aimed to identify key risk factors and develop tailored prediction models for MASLD in IBD patients. Material and methods: In a retrospective–prospective cohort of 157 IBD patients (Ulcerative colitis: 51.6%; Crohn’s disease: 48.4%), we performed serial clinical, laboratory, and imaging evaluations across four clinical visits. Hepatic steatosis was assessed using transient elastography with controlled attenuation parameter (CAP >273 dB/m). Logistic regression identified independent risk factors for MASLD, leading to the development of an additive clinical score and a logistic regression-based score. Their diagnostic performances were compared with established indices (Hepatic steatosis index (HSI), Fatty liver index (FLI)). Results: MASLD was diagnosed in 37 patients (23.5%). Independent predictors included smoking (OR 3.55), dyslipidemia (OR 2.82), hypertension (OR 2.77), prolonged IBD duration, higher BMI, male sex, frequent disease flares, and corticosteroid exposure. The additive score (cut-off ≥3) showed good sensitivity (36.1%) but high specificity (94%). The logistic score (cut-off ≥3.5) achieved moderate specificity (45.3%) with excellent sensitivity (86.1%). Both models outperformed HSI (AUC 0.671) and FLI (AUC 0.701). CAP remained the most accurate tool (AUC 0.957). Conclusion: MASLD is highly prevalent in IBD patients, driven by both metabolic and disease-specific factors. The proposed clinical scores provide simple, accessible tools for early risk stratification, potentially guiding personalized surveillance in settings lacking advanced imaging technologies.
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IBD, MASLD, Hepatic stetosis, Risk prediction model, Gut-liver axis
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