Background: MASLD is a growing public health concern associated with substantial metabolic and cardiovascular complications. Because definitive diagnostic methods are invasive, costly, and inaccessible, non-invasive biomarkers have emerged as potential alternatives. Therefore, the study aimed to evaluate the diagnostic performance of selected non-invasive biomarkers for predicting MASLD using abdominal ultrasound as the reference standard.

Method: An institution-based cross-sectional study design was used, and data were analyzed using STATA v.17. The general characteristics of study variables were compared by independent t-test, and an ROC curve was drawn, and the AUROC was used to evaluate the diagnostic accuracy for each non-invasive predictor. The optimal cut-off points of the predictors were determined by using the Youden index formula, and sensitivity and specificity together with positive and negative predictive values were calculated. A combined AUROC was drawn after multiple logistic regression was performed. Finally, correlation analysis was conducted among non-invasive MASLD predictors and study participants' characteristics. A p-value ≤0.05 was used as statistical significance.

Results: The AUROC values of FIB-4, ALT, AST/ALT, APRI, and TG/HDL were 0.98 (95% CI: 0.97-1.0), 0.93 (95% CI: 0.88-0.98), 0.18 (95% CI: 0.1-0.25), 0.79 (95% CI: 0.72-0.87), and 0.65 (95% CI: 0.55-0.75) respectively with (p ≤ 0.05). The combined AUROC was 0.99 (95% CI: 0.98-1.0).

Conclusion: FIB-4 and ALT showed an excellent diagnostic performance, while APRI and TG/HDL showed a moderate ability of MASLD discrimination. In contrast, AST/ALT showed no diagnostic ability to differentiate MASLD.

Mahider Feyisa completed her MSc at the age of 24 from the University of Gondar, Ethiopia. She is a member of the research committee of the School of Medical Laboratory Science at Debre Berhan University, Ethiopia. She has over 21 publications that have been cited several times. She is currently working on Diabetes, MASLD, Dyslipidemia, and metabolic disease. She has also been engaging in thematic research on hyperuricemia and cardiometabolic risk factors.