Steatosis-Associated Fibrosis Estimator Score in Asian Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

Abstract

Purpose: Recently, the steatosis-associated fibrosis estimator (SAFE) score was developed to predict significant fibrosis in primary care. We externally validated the SAFE score in Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Materials and Methods: We validated the SAFE score in 6229 patients who underwent transient elastography (TE) from 2012 to 2022. The sensitivities, specificities, negative predictive values, and positive predictive values of SAFE scores (two cutoffs: <0 and >= 100) for predicting fibrosis stage >= 2 were calculated. Results: Based on TE results, the SAFE score had an area under the receiver operating characteristic curve of 0.753 (95% confidence interval 0.737-0.769), outperforming the Fibrosis-4 index (0.672) and the nonalcoholic fatty liver disease fibrosis score (0.663). Non-obese and obese patients had similar sensitivities (77.0% vs. 78.4%) and specificities (61.5% vs. 51.8%) for SAFE score <0, and similar sensitivities (50.0% vs. 50.0%) and specificities (90.1% vs. 85.4%) for SAFE score >= 100. Sensitivity of the SAFE score for >= 100 increased with age, from 16.1% (age 19-30) to 79.7% (age >= 61), whereas specificity for >= 100 decreased. Conclusion: We externally validated the good performance of the SAFE score in Asian patients. The SAFE score has potential as an initial assessment to identify a low-risk population in a primary care setting.