Clinical applications and advances in noninvasive prognostic assessment of metabolic dysfunction-associated steatotic liver disease

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing global health burden, with prognosis determined by dual adverse outcomes: hepatic progression to liver-related events (LREs) and extrahepatic complications, particularly cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and extrahepatic malignancies. Accurate noninvasive prognostic assessment is therefore essential for risk stratification and individualized management. This review summarizes recent advances in noninvasive tools for predicting outcomes in MASLD. Serum-based models, spanning from established indices to emerging multi-omics and genetic markers, show robust performance for risk stratification. Imaging techniques, notably vibration-controlled transient elastography (VCTE) and magnetic resonance elastography (MRE), along with their derivative models, provide quantitative liver stiffness measurements with established prognostic value. The two-step sequential approach has been validated for integrated risk assessment. Importantly, the utility of these tools extends beyond hepatic risk stratification to the evaluation of extrahepatic complications. Despite this progress, key challenges remain: population-related heterogeneity in model performance, limited clinical applicability of complex models, and a lack of dynamic monitoring strategies. Future research should focus on multi-ethnic validation, the development of dynamic prediction models incorporating longitudinal data, and the integration of artificial intelligence (AI) to enable precision management across the full disease course.

Keywords

MASLD / LREs / noninvasive prognostic assessment / liver fibrosis / extrahepatic complications

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